Congenital Syphilis Research Articles

Antibiotic Shortage During a Public Health Crisis-The Perfect Storm.

This Viewpoint discusses the shortage of penicillin G benzathine during a surge in congenital syphilis cases in the US.

Evaluation and Treatment of Congenital Syphilis: A National Survey of US Pediatric Specialists.

Background/Objectives: As congenital syphilis incidence continues to increase yearly in the United States (US), recommendations from government and professional organizations aim to inform effective clinical practice, although it is unclear how closely these recommendations are followed. This study surveyed US pediatric specialists regarding their approach to congenital syphilis diagnosis and treatment to examine decision-making relative to practice guidelines and subspecialty. Methods: US pediatric physicians recruited from subspecialty directories were sent an online survey conducted in March-April 2024. The case-based survey elicited diagnostic and treatment decisions for different case definitions of congenital syphilis (proven or highly probable, possible, and less likely). Results: Among 442 respondents (56.8% women, 74.2% age 40-69, 57.7% 15+ years since training completion), 94.1% chose to evaluate and manage proven or highly probable congenital syphilis as recommended whereas only 45.8% did so for congenital syphilis considered less likely. Diagnostic and treatment decisions by infectious disease specialists and other subspecialists differed across case definitions. Conclusions: Physicians' approaches to congenital syphilis workup and management, including the decision to treat, varied with case presentation where decision-making seemed to diverge from published recommendations and between subspecialists as infection became less likely by case definition.

Maternal and neonatal outcomes of congenital syphilis at a tertiary care center in Turkey; a retrospective observational study

Background Maternal syphilis (MS) can lead to significant maternal morbidity and neonatal morbidity and mortality if inadequately treated. This study is aimed to retrospectively analyse the maternal and neonatal outcomes of pregnant women diagnosed with MS at our clinic. Materials and Methods We accessed the medical records of 64 cases diagnosed with MS between 2020 and 2022 from our hospital database and the perinatology clinic archives in this retrospective observational study. Case distributions by years, sociodemographic characteristics, and maternal and neonatal outcomes were recorded. Results The distribution of MS cases was 16 (25.0%) in 2020, 20 (31.25%) in 2021, and 28 (43.75%) in 2022. The mean age of the patients was 26.4 ± 6.3 years, mean BMI was 23.36 ± 3.14, the smoking rate was 31.25%, and the majority of patients were educated to primary level (37.5%). Most were housewives (43.75%), lived in urban areas (43.75%), and had lower-level incomes (68.75%). In addition, 43.75% received adequate maternal treatment, the caesarean delivery rate was 43.25%, 31.25% had preterm births, and the mean birth weight was 2956.36 + 514.46 g. CS was largely diagnosed during delivery or the postpartum period (43.75%). Fifty percent of patients were in the latent stage, gestational hypertension and preeclampsia were present in four case each (6.25%), and gestational diabetes mellitus in eight (12.5%). Twenty babies (31.25%) were admitted to the neonatal intensive care unit, eight (12.5%) had congenital anomalies, 12 had foetal growth restriction (18.25%), stillbirth was present in four (6.25%) case, and early neonatal death in four (6.25%). Conclusions Delayed diagnosis and inadequate treatment of MS can lead to significant maternal and neonatal morbidity and mortality. Well-planned antenatal care services should be provided for all expectant mothers in order to reduce these adverse outcomes.

Improving access to syphilis screening among unhoused people in Yolo County

Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis. Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive. Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program. Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

Case Report: Osteomyelitis in a healthy patient: initial presentation of congenital syphilis with negative VDRL

Case Report: Osteomyelitis in a healthy patient: initial presentation of congenital syphilis with negative VDRL

Unique Pattern of Missed Opportunities for Congenital Syphilis Prevention in Alabama Compared to National Trends

Abstract Background Missed opportunities to prevent congenital syphilis include no syphilis testing during prenatal care, late prenatal care, inadequate treatment, no prenatal care, late identification, and unidentified missed opportunities. Cases of unidentified missed opportunities are those identified as newborns with congenital syphilis born to mothers that received adequate treatment thirty days before delivery. Missed opportunities in Alabama may differ from national trends. Comparing rates of missed opportunities in Alabama to national trends may help inform Alabama physicians of the most effective intervention points for our state. Methods Data on congenital syphilis cases and rates of missed opportunities from 2018-2021 were collected from the Alabama Department of Public Health and CDC STI datasets. The occurrence of missed opportunity types in Alabama was determined and compared to national trends. Results No timely prenatal care or syphilis testing was the greatest missed opportunity nationally at 37.58%. However, the most prevalent missed opportunity in Alabama was late identification of seroconversion at 44.44% in comparison to 14.22% nationally. Second most common missed opportunity in Alabama was no timely prenatal care or syphilis testing (divided into no prenatal care at 14.81% and late prenatal care at 6.17%). Additionally, evidence of congenital syphilis despite maternal treatment was the least common missed opportunity nationally (3.75%) but made up 25% of missed opportunities in Alabama in 2021. Conclusion The incidence of late identification of seroconversion in Alabama is three times the national average, which emphasizes the need for targeted interventions to address this disparity. Furthermore, congenital syphilis despite maternal treatment in Alabama is six times the national rate, suggesting a need for further investigation into other missed opportunities.

A model of prevention of mother-to-child transmission and health management team for improving adverse outcomes of pregnancy syphilis in Ningxia, China

Regional variations exist in the implementation of Syphilis Mother-to-Child Transmission Prevention (PMTCT). Thus, it is crucial to assess the effectiveness of this model in the Ningxia region and explore the supplementary role of Health Management Teams (HMT). This study established the PMTCT + HMT model and examined its impact on adverse outcomes in pregnant women with syphilis infection. The majority of participants were urban residents, married, had a minimum high school education, and held public positions; 36.7% and 26.7% were from minority ethnic groups. The PMTCT + HMT model enhanced participants’ knowledge, rates of voluntary counseling, and testing. The incidence of adverse pregnancy outcomes (miscarriages, preterm births, stillbirths) significantly decreased, and adverse neonatal outcomes (low birth weight, neonatal mortality, congenital syphilis) were notably reduced. Simultaneously, we identified factors associated with adverse outcomes, including non-residency, unmarried status, lower educational attainment, minority ethnicity, primary syphilis, and positive titers. Thus, HMT may be an effective intervention to enhance the effect of PMTCT for syphilis. The unique population structure in Ningxia is closely linked to adverse outcomes, highlighting the significance of providing equitable treatment for vulnerable populations.

Epidemiologic Characterization and Risk Factors for Congenital Syphilis in Northeast Mexico: A Case-control Study 2016–2024

Background: Congenital syphilis (CS) is an infectious disease caused by Treponema pallidum, which is transmitted through the placenta during pregnancy. Since 2001, a notable and consistent rise in the prevalence of CS cases has been observed, especially in low- and middle-income countries. Currently, information regarding the risk factors for this phenomenon has been scarcely addressed. Methods: A case-control study was conducted to analyze the risk factors for CS. Cases of CS were defined according to scenarios 1 and 2 from Centers for Disease Control criteria, while controls were considered those from scenarios 3 and 4. Data were collected from clinical records from 2016 to 2024 from a hospital in the metropolitan area of Monterrey, Mexico. Statistical analysis was conducted through SPSS V.22. Results: In total 297 syphilis-infected mothers were included in the analyses. Multivariable logistic regression analysis showed that CS was related to late maternal diagnosis, especially after birth [OR: 4.352 (1.313–14.423)]. Additionally, women with a high nontreponemal serum test titer (≥1:8) had an increased risk of delivering an infant with CS [OR: 4.380 (1.946-9.856)]. Infants born to mothers receiving adequate treatment [OR: 0.213 (0.101-0.450)] were a protective factor. Conclusion: CS is a major public health worldwide. Adequate treatment is critical for the prevention of CS. Strategies focusing on prenatal care, early diagnosis, and adequate treatment among those with high nontreponemal titer should be strengthened to prevent CS.

A sífilis congênita nas regiões de saúde no estado de Alagoas (2009-2018)

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum. When transmission occurs from mother to child during pregnancy, it is called congenital syphilis (CS). Alagoas is among the Brazilian states with one of the highest mortality rates for CS in children under one year old. Given this scenario, this article aims to analyze the temporal trend of congenital syphilis in the Health Regions (HR) of Alagoas from 2009 to 2018. Methods: This is an ecological time series study. Sociodemographic variables and clinical aspects were analyzed. Data were obtained from the Information System for Notifiable Diseases and the Information System for Live Births. Trend analysis was conducted using the joinpoint regression model. Results: A total of 3,342 cases of CS were registered in Alagoas, with the 1st HR being the most affected (83.57%). The 8th HR had the lowest number of cases (0.18%). In terms of incidence, the 10th HR had the highest rate (14.51/1,000 inhabitants), while the 8th HR had the lowest (0.24/1,000 inhabitants). Regarding neonatal outcomes, most newborns survived (92.40%), and the majority were of mixed race (74.78%). Among maternal characteristics, there was a predominance of incomplete primary education (32.92%) and mixed race (75.08%). Conclusion: The State of Alagoas had a high incidence of CS between 2009 and 2018. The CS rate increased in almost all HRs, except for the 5th HR.

Congenital Syphilis With Multiple Bone Fractures

We report a rare case of multiple fractures occurring in a 3-month-old boy with congenital syphilis (CS). His mother was diagnosed by a gynecologist with syphilis on a screening test before his birth. After birth, a serological panel revealed positive rapid plasma reagin and treponema pallidum hemagglutination assay test results. On the first visit, his left humerus was broken. Whole-body screening radiographs showed multiple fractures of both distal radii and the right first metatarsal. Immobilization was performed with a plastic splint, and callus formation of his humerus was seen after 3 weeks. CS cases have been increasing both in Japan and abroad in recent years. Orthopaedic surgeons should not forget the possibility of CS as a differential for fractures, especially in infants younger than 3 months born to syphilis-infected mothers.

Epidemiology of Syphilis in Tokyo from 2019 to 2022: a Descriptive Epidemiological Study.

In recent years, the incidence of syphilis in Tokyo has increased. This descriptive epidemiological study aimed to elucidate the status of syphilis within the city. Data regarding age, sex, disease stage, and presumed sexual partners of patients with syphilis reported in Tokyo were compiled and analyzed. A total of 9,419 patients with syphilis were diagnosed between 2019 and 2022. A sharp rise was observed in the number of reported cases from 2021 to 2022. Between 2020 and 2022, the number of women in their 20s who developed syphilis rapidly increased by more than 3-fold. Furthermore, the number of pregnant women with syphilis increased the end of 2022. Despite a rapid increase in the number of young women with syphilis, the incidence of congenital syphilis has remained stable. This stability may be attributed to the early detection of syphilis during pregnancy, facilitated by the high rate of antenatal checkups in Tokyo. However, the growing incidence of syphilis among young women could potentially lead to a rise congenital syphilis cases in the future. Therefore, public health strategies should include educational initiatives targeting high-risk populations and adolescents, along with early and appropriate testing and treatment to prevent the progression of syphilis.

The effect of benzylpenicillin prohylaxis after birth on length and weight of syphilis-exposed infants in eastern China

BackgroundWe conducted this study to assess the impact of an intervention to interrupt mother-to-child transmission on the height and weight of syphilis-exposed infants after receiving penicillin prophylaxis after birth and to provide a scientific basis for further elimination of mother-to-child transmission.MethodsWe recruited 419 infants born to syphilis-infected mothers from 2015 to 2020 in Changzhou, and performed 1:1 matching to infants born to syphilis-free mothers during the same period. All infants were followed up to 18 months of age. We collected height and weight data and compared them.ResultsAt 18 months of age, the height and weight of the syphilis-exposed infants were almost greater than the WHO reference standards. However, when compared with local unexposed infants, there were almost no differences. The boys born to mothers who received two courses of treatment had longer body lengths at 18 months of age than did those born to mothers who did not receive two courses of treatment, and the girls born to mothers who did not receive treatment had lower body weights at 3 months of age than did both treated groups.ConclusionThe growth trajectory of infants without congenital syphilis born to syphilis-infected mothers is virtually indistinguishable from that of the general local population. Syphilis-exposed newborns can receive preventive treatment as a public health intervention.

Syphilis and pregnancy.

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.

Epidemiological profile of syphilis during pregnancy in the state of Amapá, Amazon, Brazil, between 2018 and 2022

Syphilis is a Sexually Transmitted Infection (STI) that, during pregnancy, can cause miscarriages, fetal malformations, blindness, deafness, mental disabilities, and/or stillbirth. It is considered a key tool in evaluating the quality of prenatal care. This article aimed to outline the epidemiological profile of syphilis in pregnant women in the state of Amapá, Amazon, Brazil, between 2018 and 2022, using data from DATASUS. A total of 2,069 cases of syphilis in pregnant women were reported during the study period. There was an increase in the number of cases from 282 in 2018 to 364 in 2019. In 2020, likely due to the pandemic, the number of diagnoses decreased to 309. The year 2021 saw the highest number of cases, with a total of 594 reports, followed by 520 in 2022. Most patients were mixed-race women, had completed elementary education, and were between 20 and 39 years old. The most frequent clinical classification was primary syphilis, a period with a high likelihood of vertical transmission. Although most cases were reported in the city of Macapá, the state’s capital was the only capital in Brazil where the detection rate of syphilis in pregnant women was lower than the state average. Cases from islands in Pará, such as Afuá, Breves, and Chaves, were also reported, likely due to the proximity of these municipalities to health reference centers located in municipalities in Amapá. As a result, Amapá recorded a detection rate of syphilis in pregnant women of 36.24 in 2021 and 34.52 cases per 1,000 live births in 2022, ranking as the fourth highest in the country and the second highest in the northern region. In light of these findings, there is a need for strategies to prevent syphilis in susceptible populations, as well as for appropriate diagnosis and treatment of syphilis cases in pregnant women, thus avoiding the incidence of congenital syphilis and other complications, especially in rural areas.

An Opt-Out Emergency Department Screening Intervention Leads to Major Increases in Diagnosis of Syphilis.

With rising rates of syphilis in the United States, novel strategies are needed to improve early diagnosis, particularly among priority populations such as pregnant people. As the primary source of healthcare for many communities with limited access to care, the emergency department (ED) visit represents a crucial opportunity for syphilis detection and congenital syphilis prevention. This pre-post design study examined all ED encounters for 2-year periods before and after implementation of an opt-out ED syphilis screening intervention in May 2019 at a large, urban, academic ED. Data on laboratory testing, syphilis status, and demographics were extracted from the medical record. Descriptive statistics and logistic regression were used to examine trends in syphilis screening and diagnosis. Syphilis screening increased from 5209 (3.6%) to 37 289 (24.4%) encounters. Presumed active syphilis infection (PAI) increased 288%, from 161 patients (3.1% of those screened) to 624 (1.7%). The proportion of female PAI increased from 25.6% to 42.5%, despite no change in proportion of females screened. Post-intervention, 23.6% of PAI were tested for a urogenital sexually transmitted infection (STI) in the ED and 9.0% presented with symptoms of an STI by diagnosis code. Among pregnant people, screening increased from 5.9% to 49.9% of encounters, and syphilis diagnosis increased 750%, from 2 cases to 15. Opt-out ED syphilis screening led to a dramatic increase in screening and diagnosis, especially among pregnant individuals, a priority population for congenital syphilis prevention. Most individuals with syphilis did not have STI symptoms. Opt-out screening will be an important strategy in the effort to address the syphilis epidemic.

Pendidikan Kesehatan tentang Pencegahan Infeksi Menular Seksual pada Remaja

Sexually Transmitted Infections (STIs) are diseases transmitted through sexual activity, whether vaginal, oral, or anal. However, these infections can also be transmitted outside of sexual contact, such as from mother to child (e.g., during birth or through breastfeeding) or through shared needles among drug users, as well as due to poor hygiene of the reproductive organs (http://dewibest.blogspot.com/2014/11/sap-kespro-pada-remaja.htm). STIs can be caused by bacteria, fungi, viruses, and protozoa. STIs are a significant public health issue globally, affecting both developed and developing countries. The actual incidence and prevalence of these infections are not precisely known in various countries (Fauziah Husna, 2020). According to the Centers for Disease Control (CDC) in 2022, the most frequently reported STIs worldwide include syphilis (including congenital syphilis), gonorrhea, chlamydia, chancroid, and HIV (Human Immunodeficiency Virus) (Niforatos, J.D., & Rothman, 2021).

Multi-level drivers of congenital syphilis, Oregon, 2013-2021.

Despite the availability of curative penicillin treatment for syphilis during pregnancy, congenital syphilis (CS) cases have surged in the United States, including in Oregon. We conducted a retrospective analysis of individual- and county-level predictors of CS among pregnant people with syphilis in Oregon from 2013-2021. Data were collated from surveillance reports, County Health Rankings, and other sources with upstream county-level data. We used multi-level Poisson regression models to assess associations between CS and individual- and county-level factors. Among 343 people with syphilis during pregnancy, 95 (27.6%) were associated with a case of CS. At the individual-level, a history of injection drug use and a history of corrections involvement were associated with an increased risk of CS, while a recent gonorrhea diagnosis was associated with a decreased risk of CS. County-level violent crime rate, unemployment, income inequality, and adverse childhood experiences increased the risk of CS. Higher county-level socioenvironmental challenges exacerbated CS risk, particularly among people with corrections involvement. Injection drug use, corrections involvement, and county-level socioenvironmental challenges increased CS risk among pregnant people with syphilis in Oregon. Urgent interventions are needed, including innovative care models, policy reforms targeting systemic issues, and enhanced collaboration with community services to address the escalating CS crisis.

Development and acceptability of a digital tool for promoting syphilis testing in Australian general practice: qualitative study using the Theoretical Framework of Acceptability.

Background In Australia, syphilis notifications increased 2.5-fold during 2013-2022 and 83 congenital syphilis cases were reported. Timely diagnosis and management are crucial. We developed a tool to promote syphilis testing into our existing 'Future Health Today' (FHT) software and explored its acceptability in general practice. Methods Our tool (FHT-syphilis) scans electronic medical record data to identify and prompt testing for pregnant women, and, people recently tested for sexually transmissible infection (STI) or HIV, but not syphilis. It links to relevant guidelines and patient resources. We implemented FHT-syphilis in 52 general practices using FHT for other conditions and interviewed practice clinicians (n =9) to explore it's acceptability. Data were analysed deductively guided by the Theoretical Framework of Acceptability. Results Interviewees considered syphilis an important infection to focus on and broadly viewed FHT-syphilis as acceptable for identifying patients and giving clinicians authority to discuss syphilis testing. Time constraints and unrelated reasons for a patient's visit were barriers to initiating syphilis testing discussions. Australian STI guidelines were considered appropriate to link to. Some interviewees considered prompts should be based on sexual behaviour, however this is not well captured in the electonic medical record. Two interviewees were alerted to updated Australian STI guidelines via their interaction with FHT-syphilis and expanded their syphilis testing practices. Expertise to initiate discussions about syphilis and risk was deemed important. Conclusions A digital tool for prompting syphilis testing was acceptable to clinicians already using FHT. Linkage to STI guidelines alerted some end-users to updated guidelines, informing STI testing practices.

"I Was Treated Differently": Reproductive Health Care Experiences Among Women With Recent Experiences of Incarceration, Homelessness, And/Or Substance Use in a Medically Underserved Area in the Southwestern US.

Background: Women with upstream social determinants of health, particularly those with recent experiences of incarceration, homelessness, and/or substance use, encounter a series of barriers in accessing health care services and consequently face poor sexual and reproductive health outcomes. Driven by a community concern for increasing rates of syphilis and congenital syphilis among women who are structurally disadvantaged, this study focuses on their experiences with reproductive healthcare access across healthcare settings.Research Design and Study Sample: This community-basedpláticas(conversational) research project gathered 12 in-depth interviews andtestimonios(testimonies) with women who reported a criminalized upstream barrier (incarceration, homelessness, and/or substance use) in a small city in the southwestern U.S.-most of whom identified as Latina/Hispanic.Analysis and Results: Using a grounded analysis and drawing upon Chicana feminist methodologies, this study identifies four major themes: (1) homelessness and economic vulnerabilities, (2) incarceration and health care, (3) drug use, provider stigma, and motherhood, and (4) desired changes to the healthcare experience.Conclusion: Results highlight the need for economic and transportation supports, community-based preventive services as alternatives to incarcerated healthcare, along with more compassionate and structurally competent provider-patient dialogue.

Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022.

To identify trends in stillbirth rates attributed to congenital syphilis in the United States by describing congenital syphilis-related stillbirths and comparing characteristics of pregnant people who had congenital syphilis-related stillbirths with those of people who had preterm and full-term liveborn neonates with congenital syphilis. Cases of congenital syphilis reported to the Centers for Disease Control and Prevention during 2016-2022 were analyzed and categorized as stillbirth, preterm live birth (before 37 weeks of gestation), or term live birth (37 weeks or later). Cases with unknown vital status or gestational age were excluded. Frequencies were calculated by pregnancy outcome, including pregnant person demographics; receipt of prenatal care; syphilis stage and titer; and timing of prenatal care, testing, and treatment. Overall, 13,393 congenital syphilis cases with vital status and gestational age were reported; of these, 853 (6.4%) were stillbirths. The number of congenital syphilis-related stillbirths increased each year (from 44 to 231); the proportion of congenital syphilis cases resulting in stillbirth ranged from 5.2% to 7.5%. Median gestational age at delivery for stillborn fetuses was 30 weeks (interquartile range 26-33 weeks). People with congenital syphilis-related stillbirths were more likely to have titers at or above 1:32 (78.9% vs 45.5%; P<.001) and to have received no prenatal care (58.4% vs 33.1%; P<.001) than people with liveborn neonates with congenital syphilis. The risk of stillbirth was twice as high in persons with secondary syphilis compared with those with primary syphilis (11.5% vs 5.7%, risk ratio 2.00; 95% CI, 1.27-3.13). Across all congenital syphilis cases, 34.2% of people did not have a syphilis test at their first prenatal visit. Stillbirths occurred in more than 1 in 20 pregnancies complicated by congenital syphilis. Risk factors for stillbirth included high titers, secondary stage, and lack of prenatal care. If the prevalence of congenital syphilis continues to rise, there will be a corresponding increase in the overall stillbirth rate nationally.