Congenital Syphilis on the Rise

The incidence of congenital syphilis (CS) in the United States has declined substantially in recent years and the majority of reported cases remain preventable. However, in Chicago, this is not the case. In 2012, a total of 21 cases of CS were reported to the Chicago Department of Public Health (CDPH); a 50% increase compared to 2011. The majority (82%) of mothers giving birth to babies with CS in 2012 were young and African-American (median age 22). Opportunities for earlier maternal screening or diagnosis were missed in 60% of the cases. The majority of cases were reported in nine communities concentrated in the southern and western portions of Chicago.

Perinatal transmission of syphilis can occur at any time during pregnancy and at any stage of the disease. Effective prevention and detection of CS depends on the identification of syphilis in pregnant women. Therefore, the Centers for Disease Control and Prevention (CDC) recommends routine serologic screening of pregnant women for syphilis during the first prenatal visit. However, in communities and populations in which the risk for CS is high, repeated serologic testing and a sexual history also should be obtained at 28 weeks’ gestation and at delivery. Parenteral penicillin G is the recommended treatment for syphilis in pregnancy and prevention of CS cases.

In addition, Illinois state law requires that all pregnant women be tested for syphilis at the time of the first examination, and a second test be taken during the third trimester of pregnancy. All positive blood tests, diagnoses, or treatment for syphilis should be reported to the CDPH no later than seven days after laboratory notification of positive test result.

To enhance surveillance of congenital syphilis, the CDC has released a new congenital syphilis case investigation and report form. As a result, the CDPH STI surveillance unit has also created a revised local congenital syphilis case investigation worksheet, which can be found on the CDPH website at www.chicagohan.org in the document library. The CS worksheet should be completed for all pregnant females delivering newborns at your facility and reported to the CDPH STI Surveillance Unit no later than two days after delivery.

In addition to the surveillance worksheet, CDPH is also educating women, working with health providers to offer training and working with children’s organizations, especially through the use of social media to get the word out. To report a CS case, please E-fax the worksheet to 312-745-7627. If you have any questions, please contact the syphilis epidemiologist, Irina Tabidze, MD, MPH, at 312-747-9867.