Syphilis treatment in pregnancy varies based on demographic, clinical factors

Key takeaways:

• Most women with syphilis during pregnancy received timely prenatal care.
• Substance use or a history of incarceration or homelessness during pregnancy was tied to inadequate or no syphilis treatment.

Variations in receiving adequate and timely treatment for syphilis during pregnancy highlight the need to address missed opportunities in syphilis testing and treatment, according to results of a surveillance cohort study.

“Any health care encounter during pregnancy is an opportunity to improve outcomes for pregnant people and babies by ensuring syphilis screening and prompt treatment. Congenital syphilis is preventable with timely testing and treatment prior to or early during pregnancy,” Ayzsa Tannis, MPH, epidemiologist at the CDC, told Healio. “These data reveal unique insights into how we can better protect pregnant people and their infants from syphilis.”

Tannis and colleagues evaluated data from 1,476 women (median age, 27 years) with syphilis during pregnancy as of September 2023 from six participating jurisdictions in Arizona, Georgia, Michigan, New Jersey, New York and Washington identified from the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET). Researchers compared demographic and clinical characteristics by syphilis stage and treatment status during pregnancy and by prenatal care.

Of the participants, 19.6% reported substance use during pregnancy, 8.5% reported a history of incarceration and 11.7% reported a history of homelessness. Fewer than half (40.8%) of participants were diagnosed with primary, secondary or early latent syphilis and 59.2% were diagnosed with late latent or unknown duration syphilis.

Overall, 82.2% of participants received timely prenatal care at least 30 days before the end of pregnancy, 5.1% received nontimely prenatal care and 12.7% had no prenatal care. In addition, 57.9% were adequately treated for syphilis during pregnancy, the researchers reported.

Of participants who received timely prenatal care, 17.3% received inadequate treatment and 14.8% did not receive treatment. Participants who received nontimely (RR = 2.5; 95% CI, 2.17-2.88) or no prenatal care (RR = 2.73; 95% CI, 2.47-3.02) were more likely to receive inadequate or no treatment, according to the study.

Women who reported substance use (RR = 2.04; 95% CI, 1.82-2.28), history of incarceration (RR = 1.37; 95% CI, 1.11-1.69) or a history of homelessness (RR = 1.83; 95% CI, 1.58-2.13) during pregnancy had nearly a twofold increased likelihood of receiving inadequate or no treatment for syphilis, the researchers wrote.

According to Tannis, in addition to improving access to prenatal care, approaches to improve syphilis care in settings outside of traditional prenatal care, including EDs, substance use treatment facilities, jails, prisons and shelters serving unhoused people, are needed.

“More research is needed around syphilis testing and treatment, especially highly sensitive and specific rapid tests and oral treatment options during pregnancy,” Tannis said. “Effective interventions will require innovative, multidisciplinary partnerships.”