Rise in congenital syphilis a result of multiple factors, researchers find
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The rise in congenital syphilis cases in the United States is likely a result of multiple factors, researchers said.
A study of cases in Chicago over a recent 4-year period found that pregnant women who delivered infants with congenital syphilis were more likely to have initiated prenatal care and treatment later in pregnancy than women whose infants did not have congenital syphilis, suggesting that limited access to care is a contributing factor.
They also were more likely to have noninjection substance use and psychiatric illness, the study found.
“In the years leading up to the study, congenital syphilis cases had been rising in the United States after decades of consistently low, stable incidence, which was troubling since there is effective screening and treatment,” Corinne Thornton, MD, resident doctor at the University of Illinois College of Medicine, Chicago, told Healio.
“I wanted to find out why this was happening and if there were any risk factors associated with pregnant women not getting screened or treated early enough to prevent congenital transmission,” Thornton said.
Thornton and colleagues used a local public health database to identify cases of maternal syphilis and assessed characteristics associated with diagnoses of congenital syphilis.
Of the 106 maternal syphilis cases identified from December 2014 to December 2018, 76 (72%) had a known pregnancy outcome. Among those, eight (11%) women delivered an infant with congenital syphilis.
The researchers found that women with a history of psychiatric illness (OR = 5.23; 95% CI, 1.02-26.72) and any recent substance use (OR = 5.18; 95% CI, 1.12-23.9) had higher than fivefold increased odds of having an infant with congenital syphilis, whereas prior syphilis diagnosis was associated with lower odds of congenital syphilis (OR = 0.1; 95% CI, 0.02-0.5).
Women who gave birth to babies with congenital syphilis were more likely to have late or insufficient prenatal care and initiated treatment nearly 3 months later in pregnancy (OR = 2.37; 95% CI, 0.45-12.59).
“Every case of congenital syphilis in the U.S. is preventable, and our study reinforces that congenital syphilis is a major re-emerging public health threat,” Thornton said, adding that the study also illustrated that congenital syphilis cases are “likely a result of multiple barriers that prevent pregnant women from receiving adequate prenatal and primary care.”
"Comorbidity with psychiatric illness was an unexpected finding that had not been previously shown to have a strong association with congenital syphilis,” Thornton said. “However, our study was relatively small, and it will be important to see if our findings are replicated in larger studies. If these findings hold true, it could have implications on more targeted public health interventions in areas with a high congenital syphilis burden.”
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