Identifying Unreported and Undiagnosed Cases of Congenital Syphilis in Arizona Using Live Birth and Fetal Death Registries

Background: Arizona had the highest rate of congenital syphilis (CS) in the country during the years 2003, 2004 and 2005.  During the year 2006, the state experienced a 43% decrease in the number of reported cases of CS from the previous year. The rate then increased, in 2007, back to its previously elevated levels of 32.0 per 100,000 live births, representing 30 cases.  

Objectives: To identify unreported and undiagnosed CS cases for the 2006 year, we cross-matched the live birth and fetal demise records from the Arizona vital records databases from that year with the women with any positive syphilis test results during 2005-2007 reported and recorded in the Arizona Department of Health STD database.   

Methods: Seven separate cross-matches of the three databases were completed.  Identified mother and infant matches underwent an available health department and medical record review for CS case determination. 

Results: The database cross-match resulted in the identification of six unreported cases of CS in Arizona during 2006; four live births and two still births.  The reasons for diagnosis by case were as follows; three had no prenatal test/care, one had not received treatment during pregnancy, one received treatment less than thirty days prior to delivery, and one did not have an adequate decline in RPR titer prior to delivery. 

Conclusions:  The identification and evaluation of these six  cases of CS uncovered missed opportunities for diagnosis and prevention, health department case investigation, and provider reporting.

Implications for Programs, Policy, and/or Research: The ADHS STD Control Program will use this cross-match method of CS case detection on an annual basis with particular focus on bringing to care untreated cases.  Given the importance of identifying unreported and/or untreated infants with CS, the methods presented here should be considered for use in other jurisdictions facing high or emergent CS morbidity.