Characteristics of Pregnant Women With Syphilis and Factors Associated With Congenital Syphilis at a Chicago Hospital

Abstract

Background Congenital 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. Methods Maternal 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. Results Of 106 maternal syphilis diagnoses between 2014-2018, 76 (72%) had a known pregnancy outcome; of these, 8 (11%) delivered an infant with congenital syphilis. Women with psychiatric illness and non-injection substance use each had over a five-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 three months later in pregnancy. None were HIV positive or reported incarceration, intravenous substance use, sex work, or having sex with MSM. Conclusion Maternal 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.

Spike in Congenital Syphilis, Mississippi, USA, 2016–2022

“…To combat this emerging crisis, however, it is critical to understand the different behavioral, social, and economic factors driving up maternal syphilis rates (14)(15)(16). In Mississippi, for example, the rise in the CS rate paralleled another concerning trend: rapid increase in newborn hospitalization associated with maternal substance use (17).…”

Predicting adverse pregnancy outcomes of pregnant mothers with syphilis based on a logistic regression model: a retrospective study

“…Early manifestations of syphilis in the neonatal period include aseptic meningitis, seizures, rash, and neonatal death ( 24 ). Maternal age < 25 years and maternal mental health status are risk factors for congenital syphilis, as these can be barriers to accessing primary and prenatal care ( 25 ). But this risk can be reduced by timely and adequate treatment.…”

Syphilis: recommendations for dermatologists on a resurgent epidemic

“…Although HIV pre‐exposure prophylaxis (PrEP) and antiretroviral therapy (ART) have reduced HIV incidence in men who have sex with men (MSM), they reduce the perceived risk of unprotected anal sex, associated with >6‐fold increased odds of acquiring syphilis 11–13 . Recreational drug use, associated with >5‐fold increased odds of acquiring syphilis, is also increasing 14–16 …”

“…[11][12][13] Recreational drug use, associated with >5-fold increased odds of acquiring syphilis, is also increasing. [14][15][16] Initially, the COVID-19 pandemic resulted in a decrease in syphilis cases, [17][18][19][20][21] probably related to reduced sexual encounters/testing (Figure 1). [22][23][24][25] However, a rebound in cases occurred starting mid-2020, possibly related to the gradual easing of social distancing, "quarantine fatigue," and prior interruption of clinical services (Figure 1).…”