Missed Opportunities for Prevention and Treatment of Congenital Syphilis Infection in Louisiana

Background: In 2011, Louisiana had the third highest case rate for congenital syphilis (27.6 cases per 100,000 live births), and cases continue to occur among women with prenatal care, despite opportunities for prevention. This study describes missed opportunities for prevention and treatment of congenital syphilis in Louisiana between the years 2007 and 2012.

Methods: Data were collected from CDC’s Congenital Syphilis Investigation and Report form, which is completed for every congenital syphilis case in Louisiana. A ‘Missed Opportunity’ for prevention occurred when a woman started prenatal care at least 60 days before delivery and was not adequately tested or treated for syphilis. These missed opportunities include the following: 1) lack of syphilis testing during pregnancy, 2) lack of syphilis treatment, 3) late syphilis treatment (less than 30 days before delivery), 4) inappropriate syphilis treatment (non-penicillin), and 5) lack of third trimester screening.

Results: There were 150 congenital syphilis cases from unique pregnancies between 2007 and 2012 in Louisiana. 71 of these women had prenatal care at least 60 days before delivery, and 60 of the women with prenatal care had a missed opportunity for prevention. 28 of these women did not have syphilis testing during pregnancy. 11 received late treatment, one received inappropriate treatment, and six received no treatment. 14 had a negative syphilis test early in pregnancy but were infected with syphilis by the time of delivery. None of these women had syphilis testing during the third trimester. 18 of the congenital syphilis cases received no treatment at the time of delivery.

Conclusions: These results show that most congenital syphilis cases among mothers who had prenatal care could have been prevented with timely testing and treatment. As a result legislation to support third trimester syphilis testing is being considered in Louisiana.