Qualitative Assessment of Indiana's Congenital Syphilis Case Mothers, 2014-2015

Background:  Congenital syphilis (CS) remains a problem in the U.S. with 11.6 cases per 100,000 live births reported in 2014. Indiana reported no cases between 2010 and 2013; 8 cases in 2014 (9.6 per 100,000 live births) and 7 expected in 2015.  In the U.S. in 2014, 21.8% of CS mothers received no prenatal care (PNC) and an additional 11.3% tested negative early in pregnancy but acquired syphilis prior to delivery.  Recommendations to screen and treat should be effective for women receiving adequate PNC but may not address women not receiving PNC.

Methods:  Interviews of CS mothers, maternal, and congenital case reports from 2014 and 2015 were reviewed to determine the reason for the case as a result of missed opportunity for screening or treatment on the part of the health care provider, or as attributable to maternal characteristic or behavior.

Results:  Of the 15 CS mothers, no instances were noted of screening or treatment not being performed by the provider. Average number of prenatal care visits was 2.3 and 20% of the women had no PNC. Thirty percent had a negative test early in pregnancy but were positive at delivery. Four (27%) were identified due to hospital emergency department testing. Thirty percent had no risk for syphilis except a male partner with unidentified syphilis infection. Nearly all (13/15) had public health insurance. Social factors included: multiple moves during pregnancy, drug use, domestic violence, homelessness, and non-compliance with syphilis testing or treatment.  One had prior HIV infection and three had histories of recent incarceration.

Conclusions:  More CS cases were attributable to maternal factors (15/15) than to missed opportunity by the health care system (0/15). Preventing CS may require more complex interventions that address social and behavioral issues. STD Programs should conduct a qualitative review of maternal factors on CS cases to aid program planning.