Abstract
Objective
Congenital syphilis presents a significant public health problem. Since 2012, there
has been a dramatic increase in reported cases of congenital syphilis. However, characteristics
of these cases have not been well detailed. This study sought to describe recent trends
in the incidence of congenital syphilis, demographic characteristics, hospital treatment,
and outcomes of these infants.
Study Design
A retrospective cohort study of all infants in the Pediatrix Clinical Data Warehouse
(CDW; a large multicenter de-identified dataset) from 2011 to 2020 was performed.
We identified infants with a diagnosis of congenital syphilis and evaluated trends
in overall prevalence, as well as changes in maternal and infant characteristics over
time.
Results
Of 842,928 infants discharged over the study period, we identified 1,625 infants with
congenital syphilis. Between 2011 and 2020, the prevalence of congenital syphilis
increased from 0.8 to 4.6 per 1,000 neonatal intensive care unit (NICU) admissions
(p < 0.05). Most infants were treated with penicillin for 10 days, and the median length
of stay was 10 days. Mortality was 0.9% in this cohort. Maternal coinfection with
Hepatitis C was unchanged but remained significantly above national rates of Hepatitis
C infection in pregnant women. Maternal drug use in infants born with congenital syphilis
increased from 6.1 to 24.6% over the decade of the study. The distribution of maternal
race changed over the decade, with significantly more mothers identified as White
or Other in 2019 to 2020 as compared to the earlier cohorts. There was a concurrent
decrease in mothers who identified as Hispanic or African American.
Conclusion
From 2011 to 2020, the prevalence of congenital syphilis in the Pediatrix CDW increased
by 475%. Although infant characteristics remained similar over time, there was a notable
increase in maternal drug use and a persistently elevated risk of other sexually transmitted
diseases. Further research examining the association between maternal comorbidities
and congenital syphilis is necessary.
Key Points
-
Between 2011 and 2020, the prevalence of congenital syphilis increased by 475%.
-
Mortality of congenital syphilis in live-borns stayed steady at 0.9%.
-
Maternal coinfection with other sexually transmitted diseases remained high over the
decade.
-
Maternal drug use in infants with congenital syphilis increased significantly over
the decade.
Keywords
syphilis - neonatology - infectious disease - demographics
