Congenital Syphilis - the Texas Experience

Background: In 2009, Texas ranked second in the nation for congenital syphilis reporting 126 cases, or 31.5 cases per 100,000 per live births.  As decreases in presumptive cases begin, the Texas Department of State Health Services (DSHS) will remain vigilant in identifying cases.

Objectives: To share information about the Congenital Syphilis experience in Texas

Project Description: In response to increases of presumptive congenital syphilis reports in Texas, DSHS staff implemented a comprehensive congenital syphilis plan.  The plan includes assessment of “expected” congenital reports, assessment of reports received and improved surveillance activities to ensure an expected number reports are received. Last year, evaluation of the presumptive cases characterizations was used to assess the impact that statewide legislative implementation of the CDC’s testing recommendation would have in decreasing the number of reported cases. Evaluation determined that this would have little impact because the majority of the presumptive cases did not access adequate prenatal care.  Although implementation of a state law requiring third trimester testing would not be beneficial, DSHS developed an announcement provided to health department leaders to encourage providers to implement third trimester testing for high-risk pregnant females.

Findings: Monitoring of congenital case reports contributes to the high number of presumptive cases reported out of Texas. These efforts have led to improvements in accurate case reporting, policy assessments, and action recommendations.  In spite of all of the activities around congenital syphilis, Texas will report two confirmed congenital syphilis cases for 2011, a very rare occurrence.

Conclusions: Even though protocols are implemented as designed, negative health outcomes occur. Events such as this provide an opportunity to review practices, policies and recommendations which can help keep such cases a rarity.

Implications for Programs, Policy, and Research: Even with aggressive monitoring, congenital cases can still occur.  DSHS continues to monitor these cases and evaluate methods for enhanced healthcare follow-up for women and children at risk.