Factors contributing to congenital syphilis cases—New York City, 2010–2016.
Open accessAbstract
Congenital syphilis occurs when syphilis is transmitted from a pregnant woman to her fetus; congenital syphilis can be prevented through screening and treatment during pregnancy. Transmission to the fetus can occur at any stage of maternal infection, but is more likely during primary and secondary syphilis, with rates of transmission up to 100% at these stages (1). Untreated syphilis during pregnancy can cause spontaneous abortion, stillbirth, and early infant death. During 2013-2017, national rates of congenital syphilis increased from 9.2 to 23.3 cases per 100,000 live births (2), coinciding with increasing rates of primary and secondary syphilis among women of reproductive age (3). In New York City (NYC), cases of primary and secondary syphilis among women aged 15-44 years increased 147% during 2015-2016. To evaluate measures to prevent congenital syphilis, the NYC Department of Health and Mental Hygiene (DOHMH) reviewed data for congenital syphilis cases reported during 2010-2016 and identified patient-, provider-, and systems-level factors that contributed to these cases. During this period, 578 syphilis cases among pregnant women aged 15-44 years were reported to DOHMH; a congenital syphilis case was averted or otherwise failed to occur in 510 (88.2%) of these pregnancies, and in 68, a case of congenital syphilis occurred (eight cases per 100,000 live births).* Among the 68 pregnant women associated with these congenital syphilis cases, 21 (30.9%) did not receive timely (≥45 days before delivery) prenatal care. Among the 47 pregnant women who did access timely prenatal care, four (8.5%) did not receive an initial syphilis test until <45 days before delivery, and 22 (46.8%) acquired syphilis after an initial nonreactive syphilis test. These findings support recommendations that health care providers screen all pregnant women for syphilis at the first prenatal care visit and then rescreen women at risk in the early third trimester.
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Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness.
“Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care (i.e., first visit during the second trimester or later) or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness (174,633–636).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [634]
The paper reports that absent or late prenatal care contributed to congenital syphilis cases and that substance use and unstable housing were documented barriers to care (Results and Discussion; page unavailable). It also describes sex workers and illicit drug users as groups considered at high risk for syphilis. It does not substantiate the more specific claims about multiple partners, sex associated with drug use, methamphetamine or heroin, incarceration, or homelessness; its prenatal-care finding concerns congenital syphilis prevention, not risk of acquiring maternal syphilis. (LLM, conf=0.87)
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Cites
Sexually transmitted diseases treatment guidelines (2015)
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Third-Trimester Prenatal Syphilis Screening: A Cost-Effectiveness Analysis
Albright, C. M., Emerson, J. B., Werner, E. F., & Hughes, B. L. (2015) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000997 · Cited by 31 · see citing works
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
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Syphilis in pregnancy: A practical guide for prenatal care providers
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- Authors
- Slutsker, J. S., Hennessy, R. R., & Schillinger, J. A.
- Affiliations
- New York City Department of Health and Mental Hygiene (US)
- Corresponding author
- Slutsker, Jennifer Sanderson
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2018-10-05
- Volume
- 67
- Issue
- 39
- Pages
- 1088-1093
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC6171893
- OpenAlex
- W2894853105
- Cited by
- 100
- References
- 8
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 6 · 2023: 14 · 2022: 16 · 2021: 29 · 2020: 15 · 2019: 9
- FWCI
- 9.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- New York City Department of Health and Mental Hygiene
- Council of State and Territorial Epidemiologists
- Centers for Disease Control and Prevention
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Keywords
- congenital syphilis, prenatal syphilis screening, primary and secondary syphilis, maternal syphilis, prenatal care, women of reproductive age, New York City, case averted
- MeSH terms
- Adolescent, Adult, Female, Humans, New York City, Pregnancy, Pregnancy Complications, Infectious, Prenatal Care, Prenatal Diagnosis, Risk Factors, Syphilis, Congenital, Time Factors, Practice Guidelines as Topic, Young Adult
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