ALBME

Highest Recorded Congenital Syphilis in Alabama: Let’s Stop It!

Key Message
Alabama reported 36 cases of congenital syphilis in 2021, the highest number since 2006. The reported cases were more among women who received prenatal care than those who did not receive care. The most missed opportunities to prevent congenital syphilis among prenatal care recipients in Alabama were lack of syphilis diagnosis in the early third trimester.

Key Facts
Women who are pregnant can become infected with the same STDs, including syphilis, as women who are not pregnant.

Women with a history of treated syphilis before or during pregnancy may have babies with congenital syphilis. Between 2018 and 2022, there were thirteen CS cases with unidentified missed opportunities. Our research showed that all the mothers of these infants were adequately treated thirty days before delivery. Our findings also showed that there are a few pediatricians in the state who evaluate infants born to mothers with a history of syphilis regardless of treatment history and the CDC recommended evaluation criteria. All the infants tested had either long bone X-ray abnormality, an abnormal CSF protein, or WBC values suggestive of CS, which had to be reported to the CDC as probable cases.

Untreated syphilis in pregnancy can cause miscarriage, stillbirth, prematurity, low birth weight, or death shortly after birth.

Babies born with congenital syphilis may have deformed bones; severe anemia; enlarged liver and spleen; jaundice; brain and nerve problems, such as blindness or deafness; meningitis; and skin rashes.

In 2021, 62% of the missed opportunity to prevent congenital were provider-related due to late identification, inadequate treatment, or no syphilis testing during prenatal visits. Twenty-five percent of unidentified cases were in babies born to mothers who had been adequately treated thirty days before delivery. Fifteen percent of cases were due to late or no prenatal care.

For more information about syphilis and congenital syphilis cases, please visit https://www.cdc.gov/std/

2018 2021 Number of Missed Opportunities to Prevent Congenital Syphilis Reported

Thirty-six late identifications of seroconversion by the provider during pregnancy (non-reactive initial prenatal visit syphilis test; no additional testing until labor and delivery).

Thirteen missed preventive opportunities not identified (Clinical evidence of congenital syphilis despite adequate maternal adequate treatment 30 days before deliver).

Twelve pregnant women had no prenatal care.

Nine lacked adequate maternal treatment by the provider (Bicillin injection interval > 7 days).

Six had no timely syphilis testing despite receipt of timely prenatal care (No syphilis test during pregnancy).

Five had no timely prenatal care (Prenatal care < than two months to delivery).

Syphilis Treatment During Pregnancy

Treat all pregnant women with a positive syphilis test or signs and systems of syphilis at least 30 days before delivery to prevent congenital syphilis.

Primary Syphilis, Secondary Syphilis, or Early Non-Primary and Non-Secondary Syphilis:

Benzathine penicillin 2.4 million units IM every week for two weeks at 5-7 days interval.
Syphilis Unknown Duration or Late Syphilis: Benzathine penicillin 2.4 million units IM every week for three weeks at 5-7 days interval.

All pregnant women with a history of syphilis should receive repeat treatment as Late Latent Syphilis with Benzathine penicillin 2.4 million units IM every week for three weeks at 5-7-day intervals.

Refer patient partner for treatment to prevent reinfection of the pregnant woman.
Learn more: https://www.alabamapublichealth.gov/std/syphilis-prevention.html

Contact Dr. Agnes Oberkor, DrPH, at 334-206-3913 for help with determining syphilis history and the stage of syphilis infection.

ADPH Support
ADPH offers free syphilis testing and treatment for pregnant women and their partners.
For more information, visit
https://www.alabamapublichealth.gov/std/prenatal-std-testing.html

Reporting
Report syphilis and congenital syphilis cases immediately online at https://epiweb.adph.state.al.us/redcap/surveys/?s=H37ENP8ADD or call ADPH STD Division at 334-206-5350

Points of Contact:
Dr. Agnes Oberkor, DrPH. 334-206-3913
Dr. Burnestine Taylor, MD. 334-206-5100
Mr. Anthony Merriweather, M.S.P.H., 334-206-2765