Increases in Congenital Syphilis: Are There Missed Opportunities for Intervention?

Background:
Congenital syphilis declined dramatically in Philadelphia between 1991 (301 cases reported) and 2006 (0 Cases reported). In these same years, early syphilis declined among females (1991 – 2,218 cases, 2006 – 47 cases). However, in the first 6 months of 2007, six cases were reported that meet the CDC definition.

Objective:
To determine the risk factors for the 2007 reported congenital syphilis cases in Philadelphia. To determine if any cases might have been prevented with more rigorous Disease Intervention Specialist follow-up, more robust surveillance or compliance with prenatal testing regulations.

Method:
A review of congenital syphilis cases reported in 2007.

Result:
The review of congenital syphilis cases revealed no single common risk factor. Four of the 6 cases reported were born to mothers who had no prenatal care and therefore were not afforded prenatal testing for syphilis. The two that had prenatal care were both provided testing consistent with current regulations. Five of the 6 mothers did not speak English as a first language (3 spoke Spanish and 2 spoke Vietnamese). Only one admitted to drug use and sex work. None of the cases were epidemiologically linked to any infectious syphilis cases, and none named locatable contacts that were infected.

Conclusion:
Even in the presence of robust surveillance, compliance by prenatal testing regulations, and active DIS follow-up, congenital syphilis persists.

Implications:
The prevention of congenital syphilis is largely dependent upon prenatal care programs testing according to regulations. However, not all expecting mothers utilize prenatal care. Additional interventions, such as outreach to expecting mothers whose primary language is not English are needed to further reduce congenital syphilis.