Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013

Abstract

BACKGROUND: Congenital syphilis (CS) results when an infected pregnant mother transmits syphilis to her unborn child prior to or at delivery. The severity of infection can range from a delivery at term without signs of infection to stillbirth or death after delivery. OBJECTIVE: We sought to describe CS morbidity and mortality during 1999 through 2013. STUDY DESIGN: National CS case data reported to Centers for Disease Control and Prevention during 1999 through 2013 were analyzed. Cases were classified as dead (stillbirths and deaths up to 12 months after delivery), morbid (cases with strong [physical, radiographic, and/or non-serologic laboratory] evidence of CS), and nonmorbid (cases with a normal physical examination reported, without strong evidence of infection). Annual rates of these cases were calculated. Cases were compared using selected maternal and infant criteria. RESULTS: During 1999 through 2013, 6383 cases of CS were reported: 6.5% dead, 33.6% morbid, 53.9% nonmorbid, and 5.9% unknown morbidity; 81.8% of dead cases were stillbirths. Rates of dead, morbid, and nonmorbid cases all decreased over this time period, but the overall proportions that were dead or morbid cases did not significantly change. The overall case fatality ratio during 1999 through 2013 was 6.5%. Among cases of CS, maternal race/ethnicity was not associated with increased morbidity or death, although most cases (83%) occurred among black or Hispanic mothers. No or inadequate treatment for maternal syphilis, <10 prenatal visits, and maternal nontreponemal titer ≥1:8 increased the likelihood of a dead case; risk of a dead case increased with maternal nontreponemal titer (χ2 for trend P < .001). Infants with CS born alive at <28 weeks’ gestation (relative risk, 107.4; P < .001) or born weighing <1500 g (relative risk, 43.9; P < .001) were at greatly increased risk of death. CONCLUSION: CS remains an important preventable cause of perinatal morbidity and mortality, with comparable case fatality ratios during 1999 through 2013 (6.5%) and 1992 through 1998 (6.4%). Detection and treatment of syphilis early during pregnancy remain crucial to reducing CS morbidity and mortality.

Effectiveness of treatment to improve pregnancy outcomes among women with syphilis in Zhejiang Province, China

“…In Arnesen's study, women with gestational syphilis had increased odds of stillbirth (OR=6.87) 24. Based on the report from the USA, no or inadequate treatment for maternal syphilis, infants with CS born alive at <28 weeks' gestation or born weighing <1500 g all increased the likelihood of a dead case 26. Here, we reviewed the causes of 42 new infant deaths and noticed that pneumonia, asphyxia, LBW and CS contributed greatly.…”

Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016

“…Relatively few women had 10 or more prenatal care visits; the fewer visits women had, the more likely they were to experience severe infection, infant morbidity or infant death. 6 …”

The continuing threat of syphilis in pregnancy

“…Although the case fatality rate has remained stable from 1999 to 2013 [8], the overall rate of congenital syphilis in the United States is increasing. Between 2012 and 2014, cases increased by 38% and the rate of congenital syphilis in the United States is currently 11.6 cases per 100 000 live births [9 && ].…”