Hospital identifies variables associated with maternal, congenital syphilis

Researchers reviewed a decade of maternal and congenital syphilis cases at a Brooklyn hospital and identified two variables associated with infection: racial identities other than Black or white and low socioeconomic status.

Co-author Haram Abdelmajid, MD, a pediatric infectious disease fellow at SUNY Downstate Medical Center, presented the findings at the St. Jude/Pediatric Infectious Diseases Research Conference.

Prenatal syphilis screening is universally recommended in the United States and even required by law in some states, according to the CDC. Despite this, the incidence of syphilis has continued to increase, likely as a result of multiple factors, including limited access to care and substance use, according to previous findings.

“With the pandemic ongoing, we talked about the interruption of prenatal care, and also the quality of prenatal care itself with transition to televisits instead of in-person visits,” Abdelmajid told Healio. “We [wondered], does that really affect the quality or the timing of testing, and does that lead to subsequent increase in syphilis?”

Abdelmajid and colleagues assessed 5,371 pregnant patients who delivered at University Hospital of Brooklyn from 2012 to 2021. All cases were confirmed via reactive rapid plasma reagin antibody test and a treponemal antibody test.

Among the 36 infants born to mothers who had syphilis during pregnancy, 27 (75%) required treatment due to what the researchers called “inadequate maternal treatment”: 33% with single dose of penicillin and 67% for 10 days for probable congenital syphilis.

“We actually expected to see more syphilis after the pandemic,” Abdelmajid said.

But the most “significant finding,” she said was the association of maternal syphilis with minority populations who are not Black or white, at 25% of cases vs. 7% of the 108 controls selected for the study.

Lower socioeconomic status, including lower rates of maternal employment, and not having a high school diploma or general educational diploma were also associated with syphilis.

The researchers also found that both cases and controls had fewer median number of prenatal visits during the pandemic than before, six vs. nine.

More births were covered by Medicaid during the pandemic than before, 92% vs. 73% - a population the researchers said “will be at greater risk when the public health emergency ends.”