Background:
From 1990-2003, only 15 congenital syphilis (CS) cases were reported to the Health Department. However, preliminary quality assurance audits in 2003 identified 16 unreported potential CS cases from 1990-2003; nine were confirmed and seven required additional investigation.

Objective:
To identify additional unreported CS cases from 1990-2003 and risk factors associated with CS cases.

Method:
Syphilis cases in women aged 12-50 years, from 1990-2003 were cross-matched with NM live birth/fetal death records within a potentially infectious time period of 3, 6, or 12 months prior to diagnosis for primary, secondary, and all other stages of syphilis, respectively, through 6 months after treatment for all cases. Medical records of the matched mother and possible CS cases were reviewed.

Result:
Thirteen previously unknown CS cases were identified from the 702 women, and 6 of 7 potential cases were confirmed. A total of 43 CS cases occurred in NM from 1990-2003; only 15 (35%) of which were routinely reported. Characteristics included: 30 (70%) mothers were Hispanic, median maternal age was 23 years, 16 (37%) mothers reported no prenatal care in the US, 9 (21%) had prenatal care but were not screened for syphilis, and 7 (16%) were screened for syphilis but not treated until too late in the pregnancy.

Conclusion:
Linking syphilis cases with vital records identified 30% of the CS cases occurring from 1990-2003. Lack of prenatal care and failure to screen for syphilis until too late in pregnancy left no opportunities to prevent vertical transmission in over 70% of CS cases.

Implications:
Programs can enhance CS surveillance by cross-matching syphilis registries with vital records. Additionally, programs can work to improve availability and accessibility to prenatal care for all pregnant women. Programs should educate clinicians on the importance of screening all pregnant women during pregnancy and at delivery.