Mortality Associated With Congenital Syphilis in the United States, 1992–1998

Abstract

ABSTRACT. Objective. To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality.Methods. We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992-1998.Results. From 1992-1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.4%. Untreated, inadequately treated, or undocumented treatment of syphilis during pregnancy accounted for 87.4% of reported cases. Among CS cases, there was an inverse relationship between the number of prenatal care visits (0, 1-4, 5-9, >10) and risk of fatal outcome. Among deaths, 52% of deliveries occurred by 30 weeks' gestation. Among live born infants with CS, death occurred more often in infants for whom no radiograph or cerebrospinal fluid evaluation was reported. Although both cases and deaths from CS declined from 1992-1998, there was no significant change in the case fatality ratio.Conclusion. Mortality associated with CS continues to be an important public health problem that will resurge if adult syphilis rates increase. Because a large proportion of deaths occur at low gestational age, earlier diagnosis and treatment of maternal syphilis may substantially reduce the case fatality ratio. Pediatrics 2002; 109(5). URL: http://www.pediatrics.org/cgi/content/full/ 109/5/e79; congenital syphilis, mortality, case fatality ratio, prenatal care, early treatment.

Análise dos casos de sífilis gestacional e congênita nos anos de 2008 a 2010 em Fortaleza, Ceará, Brasil

“…Of the 175 cases analyzed, nine (5.1%) resulted in perinatal mortality, with another single case (0.6%) involving missing information, which confirms syphilis outcomes during pregnancy, also described in other research studies 24,25,37 .…”

“…In Brazil, although improvements have been made to prenatal coverage indicators, good coverage and providing a minimum of six medical consultations, have not been sufficient to guarantee quality healthcare 19,22,23 . Studies also show the importance of providing quality prenatal care with an early diagnosis of syphilis in pregnant mothers, and highlight the outcome that inadequate treatment given to the mother has in relation to infant morbimortality [24][25][26][27] . Syphilis can be transmitted to a baby from the 9 th week of pregnancy onwards, although this occurs more frequently between the 16 th and 28 th week 2 , which thereby underlines the need for early diagnosis and treatment.…”

Syphilis Infection: An Uncommon Etiology of Infectious Nonimmune Fetal Hydrops with Anemia

“…If the fetus is infected, there is a high risk of an adverse outcome such as perinatal death (40%), intrauterine growth restriction, stillbirth, preterm birth, or congenital infection and anomalies [10]. Among live-born neonates with congenital syphilis, two thirds are asymptomatic at birth [11]. In brief, due to the recent resurgence of syphilis among adults, it is essential to recognize the risk it implies to young women of childbearing age.…”

Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries

“…[6][7][8][9] There are still reports on congenital syphilis occurring in industrialized countries like the United States, Great Britain or Germany, and some fi gures even indicate a rising incidence of congenital syphilis in these countries despite a highly developed antenatal and postnatal health care system. [11][12][13][14][15] But the overwhelming proportion of cases of congenital syphilis (>90%) occurs in developing countries with scarce resources. [6][7][8][9] This tragedy continues despite the fact that congenital syphilis would be almost completely preventable by early diagnosis of maternal syphilis and adequate treatment during pregnancy.…”