Syphilitic Stillborns in Chicago, IL 2002-2008

Background:Between 2002 and 2008, congenital syphilis (CS) cases in Chicago decreased by 54% (from 26 to 12 cases), parallel to the 37% (from 43 to 27 cases) decline of primary and secondary (P&S) syphilis among women during this period.

Objectives:To evaluate the demographic characteristics of women delivered syphilitic stillborns in Chicago.

Methods:CS surveillance data reported to the Chicago Department of Public Health (CDPH) from 2002-2008 were analyzed.  All cases were defined based on the CDC CS surveillance case definition. 

Results:Between 2002-2008, 109 CS cases were reported including 97 live births and 12 stillborns (overall case fatality ratio = 11%). Case fatality rate increased by 9% (7.6% in 2002 vs. 8.3% in 2008). All women who delivered stillborns were single, African American women with a median age of 20 (range 16-37). Information on prenatal care was available for 83% (10/12) of women. The majority (60%) of mothers did not receive any prenatal care, while only 4 women received some prenatal care (median # of visits =2). None of mothers who received some prenatal care were treated and as results delivered stillborns. Among CS stillbirths, 75% of deliveries occurred by 33 weeks of gestation.

Conclusions:Racial/ethnic minorities continue to have the highest number of cases and deaths due to congenital syphilis. Lack of prenatal care was identified as a major risk factor in delivering syphilitic stillborns in Chicago. Syphilis prevention activities targeting heterosexuals, especially young females, must be enhanced.

Implications for Programs, Policy, and/or Research:The complex psychosocial and demographic factors surrounding CS cases necessitate a multidimensional approach to CS reduction.