Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

Park, Eun-Hee; Yip, Julie; Harville, Emily W.; Nelson, Marlene; Giarratano, Gloria; Buekens, Pierre; Wagman, Jennifer A.

doi:10.1186/s12879-022-07100-3

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…Two qualitative studies from the United States identified key socioeconomic barriers to accessing care such as stigma and shame around social vulnerabilities, lack of education, distrust of healthcare systems, substance abuse and inadequate provider training. Public health policies need to be tailored to address these issues [29 ▪ ,30].…”

Section: Testing In Pregnancymentioning

confidence: 99%

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Thean¹,

Moore²,

Nourse³

2022

Current Opinion in Infectious Diseases

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Purpose of reviewIn light of alarming increases in the incidence of congenital syphilis in many middle and higher income countries across the globe, this review summarizes recent changes in the epidemiology of syphilis, highlights recommended changes to testing in pregnancy and provides an update for the management of syphilis infection in pregnancy (SIP) and of the infant born to a mother with SIP.Recent findingsThe re-emergence of congenital syphilis is a result of increasing infectious syphilis in women of childbearing age, which is in turn a result of increasing syphilis in the general population particularly in Indigenous and marginalized populations. Potential reasons for the increase include changing sexual practices and increased travel and migration, as well as factors that limit healthcare access, particularly access to antenatal care and limited awareness and education amongst mothers and maternity services. A single antenatal test for syphilis is insufficient; more frequent testing in pregnancy is necessary even for women deemed to be low risk. The management of SIP and of the newborn is complex and guidelines should be readily available with clear recommendations.SummaryCongenital syphilis is preventable. The current crisis calls for a global and national multipronged, co-ordinated approach involving public health and hospital systems which includes education of individuals and healthcare workers, availability of updated guidelines for prevention and treatment, prioritization of antenatal testing, assurance of accessible and prompt treatment and appropriate assessment and follow-up of infants.

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Section: Testing In Pregnancymentioning

confidence: 99%

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Thean¹,

Moore²,

Nourse³

2022

Current Opinion in Infectious Diseases

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“…This was followed by a lack of timely prenatal care in 28% and late identification of seroconversions in 11% [14]. Entry gaps to prenatal healthcare, retention gaps between prenatal visits, syphilis testing, and treatment appointments are obstacles to care, especially in at-risk populations struggling with poverty or substance use [16]. Persons who use substances of abuse during pregnancy may also avoid prenatal healthcare due to fear of judgment and legal consequences from healthcare providers, further increasing the risk of delayed diagnosis and missed or delayed treatment for this particularly vulnerable group [16].…”

Section: Epidemiological Trendsmentioning

confidence: 99%

“…Entry gaps to prenatal healthcare, retention gaps between prenatal visits, syphilis testing, and treatment appointments are obstacles to care, especially in at-risk populations struggling with poverty or substance use [16]. Persons who use substances of abuse during pregnancy may also avoid prenatal healthcare due to fear of judgment and legal consequences from healthcare providers, further increasing the risk of delayed diagnosis and missed or delayed treatment for this particularly vulnerable group [16]. Methamphetamine and heroin use have been identified as risk factors [1] for acquiring syphilis during pregnancy and may partially explain the high concentration of CS cases in the Southwestern US [17].…”

Section: Epidemiological Trendsmentioning

confidence: 99%

“…For example, focus groups with pregnant women and semi-structured interviews with prenatal care providers on the gaps in CS prevention in Kern County, California, found that underserved pregnant people experienced disproportionate challenges in access to care, and social, economic, and cultural barriers significantly impacted patient retention. Thus, it is imperative that prenatal care providers are trained to identify at-risk individuals and that clinics and hospitals are supported with resources to maintain patient follow-up and continued care [16].…”

Section: Perinatal Syphilis Prevention and Managementmentioning

confidence: 99%

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Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update

Fang¹,

Partridge²,

Bautista³

et al. 2022

Cureus

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Congenital syphilis (CS) has dramatically increased in the United States (US) in the past decade despite the widespread availability of penicillin. Once considered an infection on the verge of elimination, CS has reemerged as a familiar neonatal pathogen in US hospitals. This rise in cases has prompted the evaluation of potential causes and updates in prevention and management guidelines. Following a structured narrative approach, we reviewed CS data reports, peer-reviewed research articles, and updated management guidelines from state health departments over the past two decades. Our main search criteria centered on the treatment and prevention of CS, with a focus on prenatal health disparities. We identified geographical regions reporting disproportionate rates of CS, examined state laws regarding maternal syphilis testing, and evaluated potential reasons for the recent rise in cases. This article examines the current epidemiology, screening, and management recommendations for perinatal and CS in the US. It also reviews pathogenesis and clinical features in perinatal and pediatric populations. Finally, it highlights the likely contributing factors to increased CS rates and identifies areas for future research. Dramatically rising CS cases in certain regions and racial groups reflect gaps in the prevention, timely diagnosis, treatment, and management of perinatal syphilis and CS. Healthcare providers attending to mothers and children should recognize the reemergence of this pathogen and be familiar with new screening and management guidelines. Increased federal funding for targeted interventions and research that address vulnerable populations is critical to curbing the re-emergence of this infection.

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“…4 Gaps in prevention efforts relate to limited access to prenatal care, social and psychological barriers, cultural factors, substance use, and domestic or intimate partner violence. 8 Addressing these challenges requires implementing personalized public health interventions and healthcare strategies to control and eliminate syphilis infection. These interventions aim to bridge gaps, provide targeted interventions, and ensure comprehensive care to prevent and address the spread of syphilis.…”

Section: Introductionmentioning

confidence: 99%

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial

et al. 2023

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Background Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. Methods A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. Results The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains ( p < .05). The IG demonstrated an increase in post-test knowledge scores ( p = .001), with association between post-test scores and treatment adherence ( p = .001). Conclusion The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.

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Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

Cited by 18 publications

References 30 publications

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial

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