Congenital syphilis occurs when a pregnant patient with syphilis passed the infection on to their baby. It can cause miscarriage, stillbirth, and even infant death. Babies born with syphilis can face lifelong medical issues. The good news is that syphilis can be prevented with timely testing and treatment during pregnancy. But a new report from the Centers for Disease Control (CDC) shows that we’re missing opportunities to prevent congenital syphilis and save lives.
The report in CDC’s Morbidity and Mortality Weekly Report (MMWR) highlights important gaps in prenatal care and syphilis testing that led to preventable cases of congenital syphilis. Researchers examined congenital syphilis cases in Clark County, the most populous county in Nevada, from 2017-2022. In 2022, Nevada ranked eighth in the United States in rates of reported cases of primary and secondary syphilis and congenital syphilis.
Lack of Prenatal Care and Missed Opportunities for Testing and Treatment
The report notes that from 2017 to 2022, 530 women in Clark County, NV, tested positive for syphilis during pregnancy. More than one-third (195 out of 530) of these women had babies with congenital syphilis. Notably, only 43.1% of these women had access to standard prenatal care during pregnancy.
Lack of prenatal care means many missed opportunities to diagnose and treat infection. Health care providers in Nevada are required by law to screen pregnant patients for syphilis three times—during the first prenatal visit, early in the third trimester of pregnancy, and at the time of delivery. While the policy is in place to prevent congenital syphilis, patients without access to standard care can fall through the cracks.
Despite the lack of prenatal care, many women whose babies had congenital syphilis had other encounters with the healthcare system during their pregnancies. More than half (57.4%) visited the emergency department at least once 30 days before giving birth. Yet only 68.4% of these visits included syphilis testing. Recent research has shown that testing pregnant patients for syphilis in emergency departments can help catch cases of syphilis that may otherwise go undetected.
Implications for Public Health Practice
These findings clearly highlight the need to improve access to prenatal care to ensure timely syphilis testing and treatment. The report also suggests expanding syphilis screening of pregnant patients to nontraditional care settings, such as emergency departments. Connecting patients who test positive to timely care is also essential, regardless of the setting.
This is evident from the report from Clark County and from what researchers see nationwide. CDC estimates that timely testing and treatment during pregnancy might have prevented 88% of the cases of congenital syphilis in 2022.
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