Missed Opportunities for Congenital Syphilis Prevention in an Urban Southeastern Hospital

Background: Despite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem. Goals: To identify missed opportunities for congenital syphilis prevention during prenatal care. Study Design: Retrospective med...

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Published in:	Sexually transmitted diseases 2001-02, Vol.28 (2), p.92-98
Main Authors:	WARNER, LEE, ROCHAT, ROGER W., FICHTNER, RONALD R., STOLL, BARBARA J., NATHAN, LAWRENCE, TOOMEY, KATHLEEN E.
Format:	Article
Language:	eng
Subjects:	Adult Bacterial diseases Bacterial diseases of the genital system Biological and medical sciences Female Georgia - epidemiology Health care Hospitals, Urban Human bacterial diseases Humans Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Infectious diseases Mass Screening Medical sciences Medical screening Population Surveillance Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - drug therapy Pregnancy Complications, Infectious - microbiology Prenatal Care Prenatal development Prevalence Prevention Retrospective Studies Risk Factors Sexually transmitted diseases STD Syphilis, Congenital - prevention & control Syphilis, Congenital - transmission Urban Health Women
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Summary:	Background: Despite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem. Goals: To identify missed opportunities for congenital syphilis prevention during prenatal care. Study Design: Retrospective medical record review of 157 live birth or stillbirth deliveries that involved cases of congenital syphilis from Grady Memorial Hospital (Atlanta, GA). Results: The hospital congenital syphilis prevalence was 8.2 cases per 1000 live births. Six percent of case patients were HIV positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cases attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%, = 0.01). Conclusion: Provider efforts to reduce congenital syphilis in high-risk populations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the third trimester (i.e., 28 weeks); (2) performing on-site testing and same-day treatment; (3) providing appropriate treatment to infected women with penicillin allergy; (4) referring sex partners for treatment to prevent reinfection; and (5) screening all pregnant women attending emergency clinics.
ISSN:	0148-5717 1537-4521