Identifying missed prevention opportunities: maternal and congenital syphilis in hospital records and birth certificates in California from 2011 to 2021.

Maternal and congenital syphilis in Shanghai, China, 2002 to 2006

BackgroundThe global rise in maternal syphilis prevalence and congenital syphilis incidence over the past decade has been concerning. In South Brazil, a promising stabilization in these rates has been undermined since the COVID-19 pandemic began. This study examines the pandemic's impact on the epidemiological trends of maternal and congenital syphilis.Holt-Winters Forecast of maternal syphilis monthly prevalence rates 2010-2022Observed monthly rates used in forecast represented by black dots and connecting black line with gray upper and lower 95% confidence intervals on pre-pandemic panel.Holt-Winters seasonal monthly forecast shown as lime green dots and connecting lime green line with dark green upper and lower 95% confidence intervals.Observed monthly rates not used in forecast represented by blue circles and blue connecting line with gray upper and lower 95% confidence intervals on pandemic panel.MethodsWe conducted a retrospective review of hospital records from a South Brazilian tertiary care center, covering the period from January 1, 2010, to December 31, 2022. Assessment of gestational syphilis status was performed using prenatal syphilis records. Maternal syphilis status at delivery and congenital transmission rates were extracted from all recorded deliveries. A Holt-Winters seasonal forecasting model was used to predict maternal syphilis prevalence from pandemic onset, against which we compared actual pandemic period rates. Using data from 2017-2022, a more detailed analysis of total births and corresponding rates of maternal syphilis, congenital transmission, and infant outcomes was performed.Total deliveries and total maternal syphilis prevalence per year 2017-2022Bar height in green represents total number of births per year in left panel.Bar height in right panel represents total maternal syphilis prevalence for that year with 95% confidence intervals.Blue section of bar represents percentage of patients diagnosed with syphilis during prenatal care.Yellow section of bar represents percentage of patients diagnosed with syphilis at delivery.* Indicate statistically significant differences (Wilson/Brown p<0.05) between total maternal syphilis rates between yearsResultsProjections using 2010-2019 data indicated a potential stabilization in maternal syphilis during the subsequent COVID-19 pandemic years. Contrary to this, the actual rates recorded during 2020-2022 were much higher than those predicted. In 2021 and 2022, forecasting predicted an average yearly rate of 8.7% and 8.8%, while the observed average yearly rate was 12.5% and 10.3%, respectively. Total births throughout 2017-2022 remained stable with a small decline in the pandemic period. With most cases detected at delivery, 2020 saw an artificial decline in total syphilis prevalence at 9.1% that proceeded to increase significantly to 14.5% in both 2021 and 2022. Congenital syphilis transmission initially showed a decrease from 58% to 26% pre-pandemic and rose to 31% in 2022. The incidence of pregnancy terminations and fetal demises in syphilis positive patients declined throughout the period and stabilized at approximately 15 cases per year.Total black bar height represents total maternal syphilis cases for that year.Blue section of bar height represents total number of congenital syphilis transmission events for that year.Percentage next to blue bar height displays congenital syphilis transmission incidence.ConclusionThe COVID-19 pandemic has been a significant setback in the recent progress made against maternal and congenital syphilis in South Brazil. It is imperative that post-pandemic health strategies prioritize the reinstatement of interventions targeting these infections.Gestational syphilis infant birth outcomes 2017-2022Total bar height represents total maternal syphilis cases for that year.Blue section of bar height represents total number of infants born alive to syphilis positive patients.Black section of bar height represents total number of abortions/fetal demises in syphilis positive patients.Yellow section represents missing data, or patients who delivered elsewhere.DisclosuresAll Authors: No reported disclosures

BackgroundThe global increase in maternal and congenital syphilis cases over the past decade has been substantial. In south Brazil, preexisting maternal and congenital syphilis epidemics have been worsened since the onset of COVID- 19. We evaluated the impact of the COVID- 19 pandemic on the epidemiological trends of maternal and congenital syphilis in Porto Alegre, Brazil.MethodsWe conducted a retrospective review of hospital records from a large public hospital network, covering the full period of January 1, 2010, to December 31, 2022. Based on historical maternal syphilis and congenital syphilis cases from 2010 to 2019, a Holt-Winters seasonal forecasting model was used to predict maternal syphilis prevalence from 2020 to 2022. A subanalysis of total births, corresponding maternal syphilis prevalence, congenital syphilis cases and infant outcomes was performed for 2017 to 2022 to take a closer look at the years preceding and following the pandemic onset. The diagnoses of maternal and congenital syphilis were determined according to the Brazilian Ministry of Health guidelines.ResultsThe Holt-Winters model predicted relatively stable maternal syphilis prevalence from 2020 to 2022. In contrast, the observed prevalence at delivery was higher than predicted: in 2021 and 2022, forecasting predicted average yearly prevalences of 8.7% and 8.8%, while observed prevalences were 12.5.% and 10.3%. Total births throughout 2017–2022 remained stable with mild decline in the pandemic period. Total maternal syphilis prevalence did not change from 11.1% in 2019 to 2020. However, the percentage of patients diagnosed with syphilis at delivery increased from 14% in 2019 to 65% in 2020. A statistically significant increase in total maternal syphilis prevalence from 11.1% in 2020 to 14.8% in 2021, p ≤ 0.05 was noted. Congenital syphilis diagnoses decreased from 57 to 24% during the pre-pandemic period and increased to 27% in 2022. The incidence of fetal demise in syphilis-positive patients declined throughout the study period from 14% to 6.9% equating roughly 30 cases per year.ConclusionThe COVID- 19 pandemic was a significant setback in recent progress made toward the control of maternal and congenital syphilis in south Brazil. Public health strategies should prioritize reinstatement of interventions for prevention of gestational syphilis.

(1) Background: Maternal syphilis (MS) and congenital syphilis (CS) are serious public health problems worldwide due to their high morbidity and mortality rates. (2) Objective: Evaluating the applicability of Clinical Protocols and Treatment Guidelines on case incidence trends in Brazil and Portugal. (3) Methods: The review was done through bibliographic research in two public databases and government websites from both countries, published between 2007 and 2022. All guidelines that contained CS and MS were selected. (4) Results and discussion: After evaluation, we found that Brazil and Portugal have adequate protocols for screening and treating congenital and maternal syphilis. (5) Conclusion: The results suggest that CS and MS incidence are notably higher in Brazil than in Portugal due to economic, cultural, and social disparities and the differences in territory size. Therefore, these demographic and socioeconomic factors could strongly influence efforts to fight against syphilis and thus control the infection.

Despite existence of a highly effective intervention, maternal syphilis still causes substantial perinatal morbidity and mortality, even in China, where antenatal health services are strong. This study sought to address personal, programmatic, and other risk factors for congenital syphilis (CS) and adverse pregnancy outcomes (APOs) among pregnant women in Shenzhen, China. Pregnant women attending antenatal services were offered serologic tests, and those diagnosed as having syphilis were recruited from April 2007 to October 2012. In a nested case-control study for the pregnancy outcomes of syphilis-infected women, we assessed risk factors comparing infants born with CS (group II) and with any APOs (group III) to infants without CS or APOs (group I). During the 66-month study period, we screened 279,334 pregnant women and identified 838 (0.3%; 95% confidence interval, 0.28%-0.32%) women infected with syphilis. Among infants born to syphilitic mothers, 8.2% (34/417) were diagnosed as having CS and 24.7% (103/417) were diagnosed as having APOs. Compared with group I, maternal baseline titers of nontreponemal antibodies (adjusted odds ratio [aOR], 2.13), stage of syphilis (aOR, 21.56), length of time between the end of the first treatment to childbirth (aOR, 11.93), gestational week at treatment (aOR, 2.63), and fathers' cocaine use (aOR, 15.44) and syphilis infection status (aORpositive vs. negative, 5.84; aORunknown vs. negative, 5.55) were positively associated with CS, but prenatal care (aOR, 0.11) and complete treatment (aOR, 0.20) were negatively associated with CS. Maternal age (aOR, 1.43), marriage (aOR, 2.41), history of cocaine use (aOR, 3.79) and ectopic pregnancy (aOR, 5.91), baseline titers of nontreponemal antibodies (aOR, 1.30), stage of syphilis (aOR, 8.89), length of time between the end of the first treatment to childbirth (aOR, 2.52), gestational week at treatment (aOR, 1.78), and fathers' syphilis infection status (aORunknown vs. negative, 2.02) were also positively associated with APOs, but maternal history of syphilis (aOR, 0.44), prenatal care (aOR, 0.29), and complete treatment (aOR, 0.25) were negatively associated with APOs, Syphilis was an important cause of pregnancy loss and infant disability, particularly among women who did not receive prenatal care or had late or inadequate treatment. These study results can inform antenatal programs on the importance of early syphilis testing and prompt and appropriate treatment. Some strategies targeted at other risk factors areas may be helpful.

Mother-to-child transmission of syphilis remains an important global public health problem. Untreated intrauterine infection may result in adverse events for the fetus or newborn (NB). Maternal risk factors, such as prenatal care, early diagnosis, and appropriate treatment, significantly impact the likelihood of vertical transmission of syphilis. The purpose of this review is to evaluate maternal risk factors for congenital syphilis and the characteristics of exposed NB. A total of 14 studies were evaluated, including 8 cohort studies, 4 cross-sectional and 2 control cases. A total of 12,230 women were included, with confirmed or highly probable congenital syphilis outcome, and 2285 NB. The studies evaluated risk factors for congenital syphilis, which were maternal, demographic, obstetric factors and characteristics of the exposed NB. Included in the risk factors studied, inadequate prenatal care and late onset, as well as inadequate or late treatment of maternal syphilis were significant risk factors for the outcome of congenital syphilis. When the time set of maternal diagnosis was correlated with neonatal infection, there was a tendency to worsen prognosis (more infected NB) in women diagnosed later in pregnancy, as well as in women who underwent few prenatal consultations and inadequate treatment. Women with recent syphilis with high VDRL titres had a higher rate of vertical transmission. The prior history of syphilis with adequate treatment was identified as a protective factor, resulting in lower rates of congenital syphilis. Among the epidemiological and demographic aspects surveyed, it was observed that young age, lower schooling, unemployment, low family income and no fixed residence were associated with higher risk of congenital syphilis. The association of syphilis with adverse socio-economic conditions and inadequate prenatal care suggests that the improvement of the population's living conditions and equitable access to quality health services may have an impact on the reduction of congenital syphilis.

Cases of syphilis are increasing in the United States and disproportionately affecting disadvantaged populations. One such population is Native Hawaiians and other Pacific Islanders, historically underrepresented in national data. To review cases of maternal and congenital syphilis in Hawai'i to better understand the magnitude and causes of the problem. A retrospective chart review was performed of all deliveries at the main birthing hospital in Hawai'i for the years 2022 and 2023 by mothers who tested positive for rapid plasma reagin (RPR) during pregnancy. Demographic and clinical data were collected from mothers and their neonates and compared between those with syphilis (RPR-positive/treponema pallidum particle agglutination-positive) and those without syphilis (RPR-positive/treponema pallidum particle agglutination-negative). The rate of maternal and congenital syphilis (per 100,000 births) for 2022 and 2023 combined was 487 and 296, respectively. Of 79 maternal cases, 45 (57%) received adequate care, while the others had gaps in their care, including: no prenatal care (23%), nontimely testing (21%), inadequate treatment (35%), and reinfection (21%). Identifying as Native Hawaiian, having Medicaid insurance, a history of a sexually transmitted infection, substance use, or alternative housing were associated with maternal syphilis. Congenital syphilis resulted in longer, more costly hospitalizations, discharge to alternative care, and deficient follow-up of the newborn. These findings underscore the challenges of maternal and congenital syphilis in Hawai'i. The study identified disproportionately affected groups that require focused attention. Further study is required to identify patient- and system-level barriers to care and develop realistic, culturally appropriate interventions.

Mother-to-child transmission of syphilis remains a major global public health issue, and elimination of congenital syphilis is one of the millennium development goals of the World Health Organization (1). In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low-weight births, and 102,000 infected infants worldwide (2). In China, the number of congenital syphilis cases reported annually increased from 468 in 2000 to 10,032 in 2013; the corresponding national congenital syphilis incidence rate increased nearly 26-fold, from 2.6 cases per 100,000 live births in 2000 to 69.9 in 2013 (3,4). To examine risk factors for mother-to-child transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011-July 2014 in Suzhou, in eastern China. Multivariable logistic regression results demonstrated that gestational age >36 weeks at the time of maternal syphilis diagnosis, higher maternal titers of rapid plasma reagin (RPR) and higher Treponema pallidum particle agglutination assay (TPPA) titers are risk factors for congenital syphilis. Among women with syphilis diagnosed at >36 weeks' gestational age, three quarters were migrant women. Recommendations for strengthening community and provider education about mother-to-child transmission of syphilis, early diagnosis and timely treatment of syphilis in pregnancy, and improving and providing access to prenatal care and screening migrant pregnant women with temporary residence status might reduce the incidence of congenital syphilis in China.

BackgroundSyphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn`s health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide.MethodsWe conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO.ResultsThe strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples’ health.ConclusionsMaternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis.

Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil

&#x0D; &#x0D; &#x0D; &#x0D; Background. Syphilis is a sexually transmitted infection that is most frequently found in lower socio-economic groups globally and is associated with significant maternal and fetal complications. In South Africa (SA), the last two to three decades have seen a rise in the number of people in the low and middle economic social groups seeking private specialist healthcare services.Objective. To evaluate the prevalence rates of maternal and congenital syphilis in a private specialist healthcare setting.&#x0D; Methods. The laboratory case records of women who had antenatal maternal syphilis (MS) screening using the automated chemiluminescence immunoassay (Architect Syphilis TP) in a private laboratory facility in Durban were reviewed.Results. A total of 9 740 individual maternal serum samples were analysed and 256 were Architect Syphilis TP positive, resulting in a MS prevalence rate of 2.7%. Of the less than three-quarters of exposed neonates tested (71.1%; n=182/256), 38.5% (n=70/182) were Architect syphilis TP positive. Less than a tenth of exposed neonates (2.43%; n=6) had only rapid plasma reagin (RPR) titers test whereas 26.6% (n=68/256) did not have a syphilis screen test. Based on the 182 exposed neonates tested, the congenital syphilis (CS) prevalence from the laboratory records was 7.7%. The highest rate of MS was in the ≥35 years age group.&#x0D; Conclusion. The prevalence of MS in the private specialist healthcare sector in SA is relatively high and warrants continued maternal antenatal screening during early pregnancy across all socio-economic groups. The high rate of MS in the age group over 35 years warrants further investigations and explanation.&#x0D; &#x0D; &#x0D; &#x0D;

BackgroundCongenital syphilis incidence has more than tripled in recent years, in parallel with the resurgence of syphilis among reproductive-aged women. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis through prenatal diagnosis and treatment. We aimed to describe factors associated with maternal syphilis and congenital syphilis at a public medical center in Chicago, Illinois.MethodsMaternal syphilis diagnoses were identified using a database for local health department reporting. Medical records were reviewed for infant congenital syphilis diagnoses, sociodemographic information, medical history, and other behavioral factors. Maternal characteristics associated with congenital syphilis were assessed using logistic regression.ResultsOf 106 maternal syphilis diagnoses between 2014 and 2018, 76 (72%) had a known pregnancy outcome; of these, 8 (11%) delivered an infant with congenital syphilis. Women with psychiatric illness and noninjection substance use each had a >5-fold increased odds of having an infant with congenital syphilis. Cases with congenital syphilis were more likely to have late or scant prenatal care and initiated treatment nearly 3 months later in pregnancy. None were human immunodeficiency virus positive or reported incarceration, intravenous substance use, sex work, or having sex with men who have sex with men.ConclusionsMaternal psychiatric illness and substance use may have complicated prenatal care and delayed syphilis treatment, describing a population in need of public health intervention. Women experiencing such barriers to care may benefit from closer follow-up after a prenatal syphilis diagnosis to prevent congenital transmission.

BackgroundSyphilis can be transmitted mother to child during pregnancy leading to multisystem birth defects if untreated. In Illinois, screening is mandated for pregnant women at first and third trimesters. The University of Illinois Hospital (UIH) serves a vulnerable patient population with a high syphilis prevalence. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis (CS) with early prenatal diagnosis and treatment. The aim of this retrospective case control study is to describe maternal risk factors associated with CS in a clinical setting.MethodsUsing a database used for health department reporting from 2014-2018 at UIH, 106 maternal syphilis diagnoses were identified. Medical records were reviewed for CS infant diagnosis, sociodemographic information, medical history, and potential risk factors, including multiple sex partners, HIV status, drug use, history of incarceration or sex work, and having sex with men who have sex with men (MSM). Cases were matched with controls of pregnant women with syphilis testing that was not indicative of infection.ResultsOf the maternal syphilis diagnoses identified, there were 8 cases in which CS was possible or highly probable, 68 in which CS was less likely or unlikely, and 30 that were lost to follow up. Of the possible and probable infants’ mothers, 38% had a psychiatric illness (6.80 OR, 95% CI 1.06-43.48) and 25% were homeless (12.00 OR, 95% CI 0.94-153.89). Late or scant prenatal care was seen in 75% (4.15 OR, 95% CI 0.72-23.95) and 75% had inadequate syphilis treatment. None were HIV positive or reported incarceration, intravenous drug use, sex work, or having sex with MSM.ConclusionAmong infants with probable or possible CS, there was a 6.80 increased odds of maternal psychiatric illness compared to those born to mothers not diagnosed with syphilis, which may have complicated prenatal care and delayed diagnosis or treatment. Psychiatric illness outnumbered several other known risk factors; however, these may be less often discussed during clinical encounters. Psychiatric illness history may be a risk factor and means to identify women in the clinical setting who need close follow up and outreach after a prenatal syphilis diagnosis to prevent or mitigate congenital transmission.DisclosuresAll Authors: No reported disclosures

Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study.

Syphilis and congenital syphilis (CS) cases have been rising in the U.S. and internationally since the 2000s. Social factors have been shown to increase the risk of CS transmission. The COVID-19 pandemic may have contributed to increased syphilis transmission. We aimed to quantify the rise in congenital syphilis (CS) rates at a large urban hospital and the impact of the COVID-19 pandemic on CS rates. We completed a retrospective chart review of 61 pregnant women with a positive test or previous diagnosis of syphilis at an urban academic hospital between 1 January 2016 and 1 June 2022. Maternal syphilis and CS rates increased over the 5 years (p < 0.001), particularly pre- and post-COVID-19 (p < 0.001). Of the mothers studied, 34.6% received adequate prenatal care, 62.7% received adequate screening, and 81.3% received adequate treatment. Stillbirth was noted in 6.6% of pregnancies. Of liveborn infants, 97.6% received appropriate treatment, and 45.1% received adequate follow-up. CS development was significantly associated with homelessness (p = 0.028) and past opioid use (p = 0.031). We concluded that maternal syphilis and CS rates have increased at our hospital, particularly during the COVID-19 pandemic. Access to prenatal care and timely maternal treatment are target areas for improvement.