Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

Eunhee Park,Gloria Giarratano,Marlene Nelson,Emily Harville,Julie Yip,Jennifer Wagman,Pierre Buekens

doi:10.1186/s12879-022-07100-3

Abstract

BackgroundCongenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.MethodsBetween May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.ResultsGaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.ConclusionsCongenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.

Highlights

Prevention of congenital syphilis (CS) is critical given that untreated syphilis during pregnancy may lead to miscarriage, still birth, or blindness, deafness, and/ or bone deformities in the infant [1]
This figure is referenced in an earlier publication, presenting results collected for this study in East Baton Rouge Parish, Louisiana [16]
Four were deeply rooted in Kern county, reporting they had been in their current place of employment for more than a decade

Summary

Introduction

Prevention of congenital syphilis (CS) is critical given that untreated syphilis during pregnancy may lead to miscarriage, still birth, or blindness, deafness, and/ or bone deformities in the infant [1]. While CS can be fully prevented through timely syphilis screening and adequate treatment during prenatal care, the number of CS cases in the United States (U.S.) continues to rise. In 2018, California was the U.S state with the second highest number of CS cases (332 cases), after Texas (367 cases) [3]. The sharp rise of CS cases in Kern County paralleled an increase in early syphilis infection among women during the same time period [6]. Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California

Methods

Results

Conclusion