Rise in Congenital Syphilis May Indicate Inadequate Prenatal Screening
Increasing rates of congenital syphilis (CS) in the United States may indicate inadequate access to prenatal care, including screening among vulnerable women, according to a study published Nov. 13 in Morbidity and Mortality Weekly Report. CS has serious consequences, including death, but is largely preventable with proper identification of maternal infection and treatment with penicillin before birth. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) analyzed national surveillance data (2008 to 2014) to calculate rate and identify demographic and clinical characteristics of infants with CS and their mothers. CDC Syphilis Testing Recommendations The CDC recommends that syphilis screening includes: All pregnant women at their first prenatal visit. Repeat screening at the beginning of the third trimester and at delivery for women at increased risk (including living in high-morbidity geographic areas). Rapid plasma reagin screening at the time that a pregnancy is confirmed, if access to prenatal care is sub-optimal. Determining syphilis serologic status of the mother before newborn discharge, if not assessed during pregnancy or delivery. Testing of any woman who delivers a stillborn infant. Data from the National Notifiable Diseases Surveillance System shows that the overall rate of reported CS decreased from 10.5 to 8.4 cases […]
Increasing rates of congenital syphilis (CS) in the United States may indicate inadequate access to prenatal care, including screening among vulnerable women, according to a study published Nov. 13 in Morbidity and Mortality Weekly Report.
CS has serious consequences, including death, but is largely preventable with proper identification of maternal infection and treatment with penicillin before birth. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) analyzed national surveillance data (2008 to 2014) to calculate rate and identify demographic and clinical characteristics of infants with CS and their mothers.
| CDC Syphilis Testing Recommendations |
The CDC recommends that syphilis screening includes:
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Data from the National Notifiable Diseases Surveillance System shows that the overall rate of reported CS decreased from 10.5 to 8.4 cases per 100,000 live births from 2008 to 2012. However, from 2012 to 2014 the national CS rate increased to 11.6 cases per 100,000 live births, the highest CS rate reported since 2001. This increase was seen in all U.S. reporting regions and all racial/ethnic groups. The rising rate of CS was expectedly accompanied by an increase in the rate of primary and secondary syphilis in women.
Among mothers of infants with CS in 2014, 21.8 percent received no prenatal care. Of the 135 mothers who received no treatment but had one or more prenatal visits, 21 women were never tested for syphilis during pregnancy and 52 mothers tested negative for syphilis in early pregnancy and subsequently acquired syphilis before delivery. The remaining 62 mothers tested positive, but were not treated.
“Addressing CS will depend upon health care providers and STD programs being aware of infectious syphilis among women of reproductive age… [and] instituting more thorough prenatal screening practices when warranted,” write the authors led by Virginia Bowen, Ph.D., from the CDC in Atlanta, Ga. “STD programs might also consider enhancing surveillance efforts by determining pregnancy status on all reported syphilis cases in women and by monitoring the screening and treatment practices among prenatal care providers in communities at highest risk for delivering an infant with CS.”
Takeaway: While barriers exist in access to prenatal care, more widespread prenatal syphilis screening may cut the rate of congenital syphilis cases.
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