Congenital Syphilis Infection Research Articles

Provider-Reported Barriers in Sexual Health Care Services for Women With Upstream Barriers: The Case of Syphilis and Congenital Syphilis in Southern Colorado, 2022.

Syphilis and congenital syphilis rates have increased sharply in Colorado in the past 5 years. Congenital syphilis is passed during pregnancy in utero and can cause lifelong physical, developmental, and neurologic problems for the child, or can lead to miscarriage, stillbirth, or early infant death. Congenital syphilis is easily prevented if the mother receives timely testing, treatment, and prenatal care. Providers can play a key role in preventing congenital syphilis for women with social vulnerabilities, who have a higher likelihood of syphilis and/or congenital syphilis infection. We surveyed 23 and interviewed 4 health care providers in southern Colorado in 2022 to record their experiences in providing sexual health care services. We asked providers with direct care experience about perceived barriers in effectively treating syphilis. The most significant barriers reported in the survey were the cost of treatment (26%) and the loss to follow-up (22%). Interviews revealed further challenges, including discretionary testing procedures, delays in screening results, treatment referral issues, and stigma around substance use and sexual activity. Elevated syphilis and congenital syphilis rates pose significant public health challenges. Coordinated interventions are necessary to effectively reduce the transmission of syphilis and congenital syphilis among women with upstream barriers. Potential care solutions include expanding rapid, point-of care testing and treatment options, supporting bicillin delivery or web-based inventory systems, offering anti-stigma training for providers, offering mental and behavioral health resources at providers' clinics, and expanding partnerships with syringe access programs.

1619. Epidemiology of Congenital Syphilis Infections in Northwestern (NW) Iowa Witnessing a Significant Increase- Experience of a Tertiary Care Center

Abstract Background According to the CDC, STI (sexually transmitted infections) including syphilis infections in adults have recently increased in the upper Midwest. Studies evaluating epidemiology of Congenital syphilis (CS) are needed to facilitate prompt recognition to prevent sequelae. Methods We retrospectively studied epidemiologic, clinical characteristics and outcomes of neonates with CS at our tertiary care center which is the largest maternal/neonatal center in NW Iowa during 1/1/2021-12/31/2022 (labeled P2). Epidemiologic characteristics during P2 were compared with the period from 1/1/2019-12/31/2020 (labeled P1). Diagnosis and treatment for CS were in accordance with CDC/American Academy of Pediatrics Committee on Infectious Diseases Red Book guidelines. Results During P2, a total of 42 newborns were diagnosed with CS compared to 0 during P1 (p< 0.05); 64% of infected newborns were White followed by Native American (21%), Hispanic (11%) and Black (2%). All (100%) neonates with CS were born to mothers infected during or after second trimester of pregnancy with negative first trimester RPR (Rapid Plasma Reagin) testing. Maternal RPR titers ranged from 1:1-1:256. Majority (62%) of newborns were diagnosed with proven/possible CS with RPR-titers > 4-fold mother's titers /untreated or inadequately treated maternal infection and required 10 days of intravenous Aqueous crystalline penicillin G treatment and NICU care; 2 newborns had meningitis and 3 developed sensorineural hearing loss. Thirty-eight% received 1 dose of intramuscular Benzathine penicillin G. Need for cerebrospinal fluid syphilis testing and 10 days of intravenous penicillin treatment increased by > 600% from P1 to P2 (p=0.02). CS evaluation/treatment in infected Native American neonates increased by > 1000% in P2 (p< 0.001). Mean hospitalization duration was 9.5 (±1.6) days. No infant died. Only 33% of infants followed up at 2 months for repeat testing. None of the Native American/Hispanic/Black neonates compared to 52% White neonates had follow-up testing (p< 0.05). Conclusion Our results show an alarming increase in CS in NW Iowa and underline the need for urgent preventive measures including STI prevention education, adequate maternal/ neonatal testing and follow-up, especially among marginalized populations. Disclosures All Authors: No reported disclosures

Sífilis congênita e recusa terapêutica da gestante: análise jurídica e bioética

Abstract Despite public policies, congenital syphilis infection remains a reality in the health system routine. Moreover, its epidemiological rates continue to be relevant and worrisome despite widespread and effective preventive methods, highly cost-effective treatments available in the Unified Health System, and high-coverage pre-natal care. A major obstacle to eradicating this scenario is treatment refusal by the progenitor. Important questions regarding medical responsibility in relation to refusal, the pregnant woman’s responsibility towards the unborn child, and the legal implications involved arise from this context. This article seeks to answer these questions and their legal and bioethical repercussions.

Examining associations in congenital syphilis infection and socioeconomic factors between California's small-to-medium and large metro counties.

To investigate differences in congenital syphilis (CS) infection between California's small-to-medium and large metropolitan counties and the socioeconomic mechanisms behind these differences. County-level data from 2019 and 2020 on CS infection and other socioeconomic covariates were obtained from the California Department of Public Health and the United States Census Bureau. Counties were stratified into small-to-medium or large metropolitan counties by the National Center for Health Statistics Urban-Rural Classification Scheme and analyzed using simple and multiple Poisson regression models. California's small-to-medium metropolitan counties reported significantly higher rates of CS incidence, female poverty, and uninsured females, and significantly lower rates of English-language speaking ability and female education level compared to large metropolitan counties. CS infection was significantly associated with female poverty and education level. Rates of CS infection in the California counties are more dependent on socioeconomic indicators than county classification itself.

Fetal and neonatal abnormalities due to congenital syphilis: Aliterature review.

The recent recrudescence of syphilis among women of childbearing age is associated with an increasing number of cases of congenital syphilis. We aimed to summarize the fetal and neonatal abnormalities due to congenital syphilis infection, particularly signs amenable to prenatal diagnosis. Eligible studies were retrieved from the PubMed collection database. Articles focusing on postnatal and antenatal abnormalities covered the periods from 1969 to 2019 and 1975-2019, respectively. This review included cohort studies, case series and case reports reporting findings regarding congenital syphilis infections described before and/or after birth. Articles were reviewed by three experts in prenatal diagnosis, and all findings were classified as amenable or not amenable to prenatal diagnosis. A total of 432 cases of congenital syphilis infection were reported. Abnormalities were described antenatally in 161 cases, postnatally in 319 cases, and in both the antenatal and postnatal periods in 57 cases. The most frequently reported signs amenable to prenatal diagnosis were abdominal abnormalities (hepatomegaly, splenomegaly, and bowel abnormalities), fetal growth restriction, and elevated middle cerebral artery peak systolic velocity in the context of ascites or atypical hydrops. Brain abnormalities were rare and never isolated. In the neonatal period, the most common abnormalities were hepatosplenomegaly, bone damage and skin lesions. We found that no individual sonographic sign or pattern of signs is pathognomonic for fetal syphilis. In fetuses with ultrasound abnormalities suggestive of congenital infection, syphilis must be considered as part of the work-up.

Exploring management of antenatally diagnosed fetal syphilis infection.

The incidence of syphilis among Canadian women of childbearing age has risen dramatically in the past decade, with a resurgence of infants born with congenital syphilis. While guidelines exist to guide maternal infection during pregnancy, there is little evidence available to guide management in situations where the developing fetus is found to be severely affected. Our patient presented in the second trimester of her pregnancy as syphilis contact. Positive serologic tests (venereal disease research laboratory titre of 1:64) and a chancre suggested primary infection. Ultrasound demonstrated a fetus at 19+3 weeks gestation with hydrops fetalis and a markedly abnormal brain. Amniocentesis confirmed congenital syphilis infection on polymerase chain reaction testing. After nine days of intravenous penicillin G, the fetal status had worsened, and the family ultimately chose a medical termination of the pregnancy. Evolving ultrasound technology has allowed us to identify severely affected fetuses, who may historically have been delivered stillborn. Following routine syphiliotherapy with benzathine penicillin, these abnormal ultrasound features may take weeks or months to reverse, which poses a challenge in prognostication and counselling. Case reports data suggests intensive treatment with intravenous penicillin may be effective in severe cases where fetal hydrops is present. This case highlights the potential morbidity of fetal syphilis infection and underscores the paucity of current literature. Information sharing will be essential to build a modern knowledge base on treating this ancient disease.

Adverse pregnancy outcomes associated with maternal syphilis infection

Background Syphilis infections affect many pregnant women worldwide every year. The increasing rates of maternal and congenital syphilis infections in recent years in the United States necessitates further investigation into the adverse effects of syphilis infection on maternal and neonatal health. Objective We sought to examine the association of maternal syphilis infection with adverse pregnancy and perinatal outcomes. Methods We performed a retrospective cohort study of women with singleton pregnancies who delivered between 23 and 42 weeks in California between 2007 and 2011. We compared demographic characteristics and pregnancy outcomes between pregnant women with syphilis and without syphilis. Maternal outcomes of interest included gestational hypertension, pre-eclampsia, gestational diabetes, preterm delivery, cesarean delivery, induction of labor, and severe maternal morbidity. Neonatal outcomes included neonatal intensive care unit admission, congenital anomaly, congenital syphilis, small for gestational age, stillbirth, neonatal death, infant death. Descriptive statistics were assessed using chi-square/Fisher’s Exact tests. Multivariable logistic regression was used to estimate the association between syphilis and adverse pregnancy and perinatal outcomes. Statistical comparisons with a p-value of less than .05 and 95% CI that did not cross the null were considered statistically significant. Results Among a cohort of 2,566,246 women, there were 991 pregnancies complicated by maternal infection with syphilis (0.04%). We found during multivariable logistic regression that syphilis infection was significantly associated with preterm delivery (aOR: 1.27, 95% CI: 1.05−1.54), NICU admission >24 h (aOR: 2.54, 95% CI: 2.13−3.04) and stillbirth (aOR: 5.01, 95% CI: 3.16−7.92) after adjusting for a number of potential confounders including maternal age, race/ethnicity, education, parity, prenatal visits, body mass index, smoking and insurance status. Conclusion Maternal syphilis infection in pregnancy is associated with specific adverse pregnancy outcomes, even after adjusting for potential confounders. These data can be used to counsel patients with syphilis in pregnancy, and in developing approaches to clinical care. Due to the increased risk of stillbirth, perhaps such patients should receive antenatal testing. Further research is necessary to investigate the mechanisms of morbidity.

An old disease on the rise: new approaches to syphilis in pregnancy.

Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options. A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely. Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.

Health status and healthcare service utilization among children born to women with maternal syphilis in Shanghai

Objective: To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy, in order to prevent mother-to-child transmission of syphilis to the newborns. Methods: Women with maternal syphilis were studied by trained researchers via phone calls, in Shanghai during 2014-2015. Data related to demographics, status of infection and health care, utilization by both mothers and their children were collected through specifically designed questionnaires. Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics. Results: A total of 495 children born to mothers with maternal syphilis were recruited from 1 000 syphilis infected parturient women. A total of 61 out of the 495 children were diagnosed as having congenital syphilis (57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period). Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis (χ(2)=7.214, P=0.027). 37.8% of the children were reported to have had different illnesses in the past three months, mainly involving upper respiratory infections (32.3%) or diarrhea (3.6%). Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases, compared to those without congenital syphilis (47.5% vs. 36.6%). 81.6% of the children had received regular child health care services. Subjects with the following factors as: being immigrant, with lower education, unemployed, unmarried and multipara, were related to the less use of regular child healthcare services. Only 39.7% of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers. Mothers with residency of Shanghai, having higher education level and employed, were less willing to inform doctors about the risk of congenital syphilis infection of their children. Conclusions: Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem. Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis, when receiving child health care services at the centers. It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.

P09.18 Suboptimal prenatal testing for syphilis and other stds among commercially-insured women in the united states, 2013

Background Prenatal syphilis screening is a critical step in the prevention of congenital syphilis infection. US guidelines recommend universal syphilis screening of all pregnant women at the first prenatal visit and again early in the third trimester and at delivery for at risk women. Methodology We analysed a large commercial claims database to estimate prenatal testing coverage for syphilis among pregnant women aged 15–44 in 2012–2013. We used procedural and diagnostic codes to identify pregnant women with a live birth in 2013. Pregnant women were included if they were enrolled in health plans at least 210 days prior to the date of delivery. Procedural codes were used to identify syphilis, HIV, and other STD testing during prenatal period, defined as 40 weeks before and on the date of delivery. Results Among 346,811 pregnant women, 82.4% had syphilis testing before the 28th week of pregnancy or before the third trimester, 84.3% before the 37th week of pregnancy, and 85.3% at any point during the prenatal period. Of these 346,811 women, 71.2% also had testing for HIV, 83.7% hepatitis B, 68.0% chlamydia, and 67.3% gonorrhoea during the prenatal period. Of 61,112 pregnant women without prenatal syphilis testing before the third trimester, only 16.6% had any syphilis testing in the third trimester or on the date of delivery. Of 285,699 pregnant women with prenatal syphilis testing before the third trimester, only 22.5% had any syphilis testing in the third trimester or on the date of delivery. Conclusions Prenatal screening for syphilis, HIV, and other STDs was suboptimal. Low syphilis testing during the third trimester or on the date of delivery among all pregnant women, especially among pregnant women without syphilis testing before the third trimester, leaves a critical gap in the prevention of congenital syphilis infection. Interventions should be developed to increase prenatal syphilis testing as recommended.

Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology.

Missed Opportunities for Preventing Congenital Syphilis Infection

To the Editor: Louisiana has experienced high and increasing rates of congenital syphilis (CS) since 2005.1 Using data from Louisiana’s Office of Public Health Sexually Transmitted Disease/HIV Program’s electronic investigation and reporting system, we reviewed data for all patients with CS born from January 1, 2010 to October 6, 2011. Similar to other recent US reports, we found women with documented prenatal care who did not receive recommended testing or treatment for syphilis.2 Fifty-five women gave birth to 57 infants identified as CS cases by the Louisiana Sexually Transmitted Disease/HIV Program; cases can be identified based on a mother’s history of untreated syphilis or findings in the infant.1 This corresponds to 51.9 cases per 100,000 births.3 Thirty-six women (65%) had documented prenatal care before 30 weeks of gestation. Of those 36, 4 (11%) had documented adequate treatment for syphilis before pregnancy, and 19 (53%) had adequate maternal treatment during pregnancy. Among those 23, 3 women had infants with abnormal evaluations. The remaining 20 women had infants who were classified as CS cases due to maternal serology or reasons that are unclear. Five (14%) of the 36 received penicillin-based treatment less than 30 days before delivery, and 8 (22%) had no treatment documented. No woman received non–penicillin-based treatment. Of the 8 women with no treatment documented, 1 had a positive syphilis test result 5 months before delivery, and 6 had their first positive test result at delivery or within 1 month of delivery, without documentation of prior negative test results. Only 1 untreated woman who tested positive at delivery had a documented negative syphilis test result at her first prenatal visit. The 5 women who received late treatment, together with the 7 women with no treatment who were tested late in pregnancy, represent 12 missed opportunities to prevent CS in Louisiana in less than 2 years. Documented infant evaluation was often incomplete, and some infants did not receive treatment. Twenty-three infants (40.3%) had a documented cerebrospinal fluid Venereal Disease Research Laboratory test, and 3 (13%) were positive. Seventeen infants (29.8%) had a documented cerebrospinal cell count/protein, and 12 (70.6%) had abnormal results. Twenty-three infants (40.3%) had documented bone radiographs, and 1 (4.3%) had an abnormal result. Three infants (5.3%) had unspecified clinical manifestations of CS documented on physical examination. Six infants (10%) were documented to have no treatment for CS during their hospitalization. Our analysis was limited to data in Louisiana’s electronic investigation and reporting system, and it is possible that clinical care occurred that was not documented by the public health workers. Congenital syphilis is preventable with quality, timely prenatal care. Although screening and treating women who do not present for prenatal care is a major challenge, providing appropriate care to those who do present is imperative. The Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecologists, and the American Academy of Pediatrics recommend universal syphilis screening of pregnant women at the first prenatal visit and repeat screening in the third trimester and at delivery in high-morbidity areas.4 By working together, health departments and providers can ensure that these guidelines are followed and that pregnant women are treated for syphilis rapidly and appropriately to prevent CS infections. Camille E. Introcaso, MD Heather Bradley, PhD Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA [email protected] DeAnn Gruber, PhD Louisiana Office of Public Health STD/ HIV Program, New Orleans, LA Lauri E. Markowitz, MD Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Missed Opportunities for Preventing Congenital Syphilis Infection in New York City

To describe health care providers' missed opportunities for preventing and treating congenital syphilis in New York City. Review of congenital syphilis cases reported to the New York City Department of Health and Mental Hygiene from January 1, 2000 to December 31, 2009. Receipt and timing of prenatal care, serologic testing, and treatment of mothers and newborns were reviewed. Missed opportunities were defined as receipt of prenatal care plus one of the following: 1) lack of documented treatment for syphilis infection diagnosed before pregnancy; 2) absence of serologic testing during pregnancy; 3) late maternal treatment; 4) maternal treatment with a nonpenicillin regimen; or 5) lack of maternal treatment. In total, 195 newborns with congenital syphilis were born to 190 mothers with 191 pregnancies. Overall, 80% (95% confidence interval [CI] 74-86%, 152 of 190) of all mothers received prenatal care; 63% (95% CI 56-71%, 96 of 152) of these had one or more missed opportunities for prevention. Twelve mothers received inadequate treatment or no treatment during the case pregnancy for documented syphilis infection before pregnancy, and 42 mothers without previous syphilis diagnosis did not have serologic testing during the case pregnancy. Of 103 mothers with syphilis diagnosed before 30 weeks of gestation, 12 received late penicillin therapy, 27 received no therapy, and 3 received inappropriate (nonpenicillin) therapy. Seventeen percent (95% CI 12-22%, 33 of 193) of liveborn newborns received no treatment during their hospitalization. Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians. III.

Congenital Syphilis, a Reemergent Disease in Mexico: Its Epidemiology During the Last 2 Decades

To describe the epidemiologic profile of congenital syphilis in Mexico between 1990 and 2009. The database of the General Direction of Epidemiology at the Ministry of Health in Mexico about congenital syphilis was reviewed. Data corresponding to the period between 1990 and 2009 were analyzed in every state of the Mexican republic. A total of 1717 cases of congenital syphilis were reported during the study period. A 16.6% increase was observed between 2005 and 2009 and the quinquennium between 2000 and 2004. A trend toward increase in the incidence of congenital syphilis was observed with 2.9 new cases for each 100,000 babies born alive. The states that displayed significant positive trends were as follows: Baja California, Colima, Chihuahua, Jalisco, Nayarit, Sinaloa, and Zacatecas. An increase in the number of cases of congenital syphilis is observed; the northern states are the ones that contribute the most to the statistics. There is a real need to refine the epidemiologic operations to detect and treat the cases of maternal and congenital syphilis in the country.

Comparative study of newborns of Asian immigrant and Korean women

Purpose : This study compares the maternal characteristics and birth outcomes of infants of Asian immigrant mothers from developing countries with those of the infants of Korean mothers. Methods : In this multicenter and retrospective study, Asian immigrant women who had delivered between January 2005 and June 2008 were enrolled from9 Medical Centers. In all, 333 births to Asian immigrant women from developing coun- tries (Asian-Korean infants) were included in this study. In addition, sex-, birth year-, and gestational age-matched 333 neonates born to Korean mothers were selected as the control group (Korean infants). On the basis of the hospital data, we investigated the nationality, age, and medical history of the mothers and compared the incidence of congenital infec- tion, Apgar score, weight, height, and head circumference of Asian-Korean infants with those of the Korean infants. Results : The average maternal age of Asian women from developing countries at birth term was 26.7 years, which was significantly lower than that of Korean women (30.8 years, P<0.05). The birth weight of Asian-Korean infants (2,869 g) was significantly smaller than that of Korean infants (2,995 g, P<0.05). There was a significant difference in the incidence of congenital syphilis infection between the Asian-Korean infants and Korean infants (5 cases vs. 0 case, P<0.05). Conclusion : There were significant differences in the perinatal outcomes between the Korean and Asian-Korean infants. A multicenter large-scaled study should be performed to analyze the perinatal outcomes of Asian-Korean infants. (Korean J Pediatr 2009;52:1119-1126)

Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease.