Maternal Characteristics of Congenital Syphilis Cases in Upstate New York, 2002-2006

Background:
Congenital syphilis (CS) cases have decreased nationwide since 1991 likely due to intervention targeting detection and treatment of early syphilis among women of reproductive age. However, the impact of programmatic efforts of public-health partner notification on CS elimination activities has not been assessed.

Objective:
To study maternal demographic characteristics, utilization of prenatal care and partner notification outcomes of pregnant women with reactive syphilis serology tests in Upstate New York in 2002-2006.

Method:
Confidential case reports for pregnant women with reactive syphilis serologies were reviewed to collect information on maternal demographic characteristics, prenatal care utilization, and syphilis treatment. The case management database was used to assess partner notification outcomes as measured by the number of partners elicited and partner's STD dispositions. Adopted CS cases were excluded due to the lack of maternal information. The maternal characteristics were compared between women who delivered babies with CS and women who did not (defined as “prenatal reactors”).

Result:
A total of 51 CS cases and 121 prenatal reactors were reported in 2002-2006. Among 43 women who delivered babies with CS, 95% did not have regular prenatal care; 75% did not receive syphilis tests in the first trimester; and <10% had documented adequate treatment for syphilis before the delivery. Compared with 121 prenatal reactors, women who delivered babies with CS were younger, more likely to be white and single, and more likely to have multiple (mean numbers=1.9 versus 1.5) and anonymous sexual partners (mean numbers=1.1 versus 0.6) during the pregnancy.

Conclusion:
In addition to screening high-risk women during the pregnancy for early detection of syphilis, therapy monitoring and partner services are also essential to reduce the incidence of CS.

Implications:
High-risk pregnant women should be followed to confirm that they were screened and adequately treated. Programmatic efforts to identify sexual partners during the pregnancy may also improve maternal outcomes.