Abstract
BackgroundThe number of congenital syphilis (CS) cases in the United States are increasing. Effective prevention of CS requires routine serologic testing and treatment of infected pregnant women. The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk.MethodsWe conducted a cross-sectional cohort study of syphilis testing among pregnant women with a livebirth delivery from January 2014 to December 2016 in Marion County, Indiana. We extracted and linked maternal and infant data from the vital records in a local health department to electronic health records available in a regional health information exchange. We examined syphilis testing rates and factors associated with non-testing among women with livebirth delivery. We further examined these rates and factors among women who reside in syphilis prevalent areas.ResultsAmong 21260 pregnancies that resulted in livebirths, syphilis testing in any trimester, including delivery, increased from 71.7% in 2014 to 86.6% in 2016. The number of maternal syphilis tests administered only at delivery decreased from 16.6% in 2014 to 4.04% in 2016. Among women living in areas with high syphilis rates, syphilis screening rates increased from 79.6% in 2014 to 94.2% in 2016.ConclusionImprovement in prenatal syphilis screening is apparent and encouraging, yet roughly 1-in-10 women do not receive syphilis screening during pregnancy. Adherence to recommendations set out by CDC improved over time. Given increasing congenital syphilis cases, the need for timely diagnoses and prevention of transmission from mother to fetus remains a priority for public health.
Highlights
Congenital syphilis (CS) results from infection in infants in utero with the bacterium, Treponema pallidum [1]
Study population We identified a total of 21260 pregnancies by 19574 unique mothers from 2014 to 2016
Because we were most interested in testing during pregnancy, demographics are given as characteristics of pregnancies rather than characteristics of mothers themselves
Summary
Congenital syphilis (CS) results from infection in infants in utero with the bacterium, Treponema pallidum [1]. Women who engage in risky sexual behaviors, use illicit drugs, have STIs (sexually transmitted infections) or multiple sex partners during pregnancy or reside in communities with increased prevalence of syphilis infection are considered high risk and recommended to be screened again between 28 to 32 weeks and at delivery [5]. These recommendations are supported by the American Congress of Obstetricians and Gynecologists (ACOG). The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk
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