Effectiveness of Prenatal Screening and Treatment to Prevent Congenital Syphilis, Louisiana and Florida, 2013–2014

Abstract

Background: From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. Methods: Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. Results: Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. Conclusions: Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.

Factors Contributing to Congenital Syphilis Cases — New York City, 2010–2016

“…To encourage early detection of syphilis in pregnant women, some states have mandated screening at the first prenatal care examination and during the early third trimester. Universal third-trimester screening effectively prevented most congenital syphilis cases in Florida and Louisiana ( 6 ); however, this strategy might not be cost-effective in low-morbidity areas ( 7 ).…”

Congenital Syphilis: A U.S. Perspective

“…[16,24,26] The same weeks gestation and delivery [7,16]. A study done in Florida and Louisiana following the guidelines in high risk pregnant women was able to pick up an additional 5% of CS cases by screening at 28 weeks and delivery for an additional treatment of 30 patients over first trimester screening only [31] However, despite the available data and clinical knowledge, the rates in the US and worldwide continue to rise and predominantly affects disadvantaged communities that have issues with poverty, substance abuse and lack of health care access. To date the US does not have a national program to mandate screening all pregnant women for CS, in fact there are still six states where there is no requirement and only a third of states require a third trimester screening [32] .…”

Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma

“…of syphilis during pregnancy, and is thus one of the most significant individual risk factors for CS. 2,6,[24][25][26][27] The CDC found that 28% of mothers of infants with CS from 1999 to 2013 received no PNC and an additional 32% received less than the recommended 10 PNC visits. 1 Third trimester screening based on regional epidemiological risk can be challenging in part because of imprecision of available data.…”