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Cost of congenital syphilis hospitalizations skyrockets with increase in cases
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The incidence of congenital syphilis-related hospitalizations among young infants increased considerably between 2009 and 2016 in the United States, according to research published in the Pediatric Infectious Disease Journal. At the same time, the cost of hospitalization charges related to congenital syphilis more than doubled.
“The reason for the reported increase in rates of congenital syphilis can be secondary to an increase in syphilis infection in pregnant women in recent years that in turn have been temporally associated to an increase in rates among men who have sex with men, coupled with an increase in drug use among women and heterosexual men,” Krishna Kishore Umapathi, MD, pediatrics resident at Metro Health Medical Center in Cleveland, told Infectious Diseases in Children.
The researchers collected identified congenital syphilis diagnoses made for children aged younger than 1 year between 2009 and 2016 throughout the U.S.
During the study period, 5,912 congenital syphilis-related hospitalizations occurred. Umapathi and colleagues called the number of hospitalizations in 2011 an “all-time low,” but the incidence rate continued to increase since that year.
Congenital syphilis-related hospitalizations were most common among black (47%; P < .001) and Hispanic infants (29%; P < .001). According to the researchers, these hospitalizations occurred most often in those with public insurance or who were uninsured (88%; P < .001) and those living in the South (59%; P < .001) or West (21%; P < .001).
Compared with hospitalizations for other conditions, infants hospitalized with congenital syphilis had longer average lengths of stay (12.38 vs. 3.42; P < .001) and health care costs ($58,502 vs. $12,592; P < .001).
The researchers reported that the total inflation-adjusted charges for congenital syphilis-related hospitalizations more than doubled during the study period, with the cost reported at $54,290,310 in 2009, climbing to $120,665,203 in 2016.
“Our study illustrates racial, socioeconomic and geographical disparities in infants affected by congenital syphilis,” Umapathi said. “Addressing these concerns in combination with a robust syphilis screening and early treatment program as part of routine antenatal care and treatment of sexual partners can play a major role in prevention of congenital syphilis. More importantly, active or multilevel surveillance rather than passive surveillance can better assess and estimate the health care burden and help guide focused prevention efforts.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Carlos del Rio, MD, FIDSA
Congenital syphilis has been on the rise in the U.S. since 2009, with close to 1,000 cases in 2017. This is not an isolated problem but a consequence of the increase in syphilis cases, the opioid epidemic and poor prenatal care.
In this study, the number of congenital syphilis hospitalizations were higher in the South. Previous CDC data show that 70% of the cases of congenital syphilis occur in five states: Florida, California, Arizona, Texas and Louisiana.
Congenital syphilis is a devastating yet preventable illness. Addressing this issue is not rocket science; improving access to prenatal care, syphilis screening and early treatment with penicillin of mothers and their partners would eliminate this problem.
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