Congenital Syphilis in Florida: Identifying at-Risk Populations in a High Morbidity State

Background:  Rates of reported congenital syphilis (CS) have declined in most southern states since 2010; however, Florida has seen a 48% increase in cases over the previous four years. The aims of this project are to identify common characteristics for mothers of CS cases and examine the occurrence of infant clinical manifestations through laboratory tests and clinical signs within 30 days after delivery. 

Methods:  All CS cases meeting the Council of State and Territorial Epidemiologists (CSTE) National Case Definition and the linked maternal syphilis cases from 2012 to 2014 were extracted from Florida’s STD case management repository, the Patient Reporting Investigating Surveillance Manager (PRISM).  Bivariate and comparative analyses were performed to examine characteristics between infected mothers of CS cases, syphilis cases giving birth to healthy babies, and nonpregnant female and male cases.

Results:  A total of 663 women with confirmed syphilis gave birth to either an infected baby (n=123) or a healthy baby (n=540).  No difference in race was observed among infected babies born to Black and Caucasian mothers (OR: 1.00; CI: 0.65, 1.55).  However, the frequency of CS cases was much higher among Black mothers (64%).  The maternal mean age was similar between syphilis cases giving birth to an infected baby and healthy baby (Infected baby: 26.1± 5.94; Healthy baby: 27.1 ± 6.28, p< 0.096).  Among CS cases, only 26 infants met the CSTE case definition based upon laboratory evidence and clinical manifestations regardless of maternal symptoms or treatment.

Conclusions:  The thorough examination identified 26 (21%) cases that met the CSTE case definition.  Reducing and preventing CS morbidity requires timely, appropriate diagnosis and treatment during and before pregnancy.  Mothers delivering CS cases were younger and disproportionately of a racial minority.  Therefore, targeted intervention efforts may be more effective if focused on minorities during their early childbearing years.