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Background: Between 2010 and 2014, congenital syphilis (CS) case numbers in Los Angeles County (LAC) increased from 7 to 31, increasing the CS rate to 25/100,000 live births. We conducted an analysis of 2015 and 2016 cases to better understand CS and maternal characteristics, in order to optimize prevention strategies.
Methods: Descriptive qualitative and statistical analyses were performed on data documented in our surveillance system, STD Casewatch, collected during CS case investigations. Data were analyzed only for LAC AAPPS-funded area, which excludes Long Beach and Pasadena. We examined clinical factors as well as maternal social and demographic characteristics.
Results: Seventy six pregnant women were diagnosed with syphilis in 2015, resulting in 21 CS cases among 20 mothers (26% failure to prevent). As of June 30th, 20 CS cases have been reported in 2016. In 2015 and 2016 to date, 2 each year (10%/11%) have manifested as stillbirths. Two more each year have involved significant impairment, including hepatosplenomegaly and/or osseous abnormalities and/or pseudoparesis. Forty percent of mothers in 2015/37% in 2016 were diagnosed with early syphilis. In 2015 55% percent and in 2016 53% received no prenatal care (PNC). Of those with at least 1 PNC visit, 14% in 2015/21% in 2016 received inadequate treatment to prevent CS, mostly due to loss to follow-up. In 5% of 2015/11% of 2016 cases, additional third trimester screening may have enabled prevention. Maternal race/ethnicity was described in 2015/2016 as 55%/47% Hispanic/Latina, 20%/16% African American, 10%/16% white non-Hispanic, 10%/11% Asian, 0%/5% Native Hawaiian/Pacific Islander, and 5%/5% unknown. Nurses identified a history of methamphetamine and/or opioid use in 64%/56% of cases with data available.
Conclusions: Analyses of recent CS cases reveal that most occur in women with minimal to no prenatal care and in methamphetamine or opioid users. Prevention efforts will focus on linkage with maternal child health programs and those targeting substance abusers.