Congenital syphilis

The incidence of congenital syphilis declined 21% between 2000 and 2002, with the largest decreases occurring in the groups where the incidence had been highest--racial and ethnic minorities and women living in the South--the Centers for Disease Control and Prevention reported.

There were 578 reported cases in this country in 2000 and 451 cases in 2002, according to the federal agency's surveillance.

The decreases continue a pattern of decline in syphilis seen throughout the 1990s and follow the 1999 implementation of the National Plan to Eliminate Syphilis (MMWR 53[31]:716-19, 2004).

Between 1997 and 2002, the incidence rate of congenital syphilis declined 63%. Recently, however, it has been noted that the rates of primary and secondary syphilis have been rising among men, particularly among men who have sex with other men.

Other observations noted in the report include the following:

* Many of the cases occurred in women who had no documented treatment or received inadequate treatment, even though it appeared that many had received prenatal care. Of the 288 cases reported for 2002, 63% of the mothers received prenatal care.

In 238 cases, the trimester in which the first prenatal visit occurred was known. In 86 cases, prenatal care began in the first trimester. In 93 cases, it began in the second trimester. In 59 cases it began in the third trimester.

Eighteen mothers had a first visit less than 30 days before delivery.

This may indicate that providers are not adhering to syphilis screening recommendations, the report said. A 1999-2000 survey of obstetricians found that 14% of ob.gyns. did not report routinely screening pregnant women, and many who do screen do so only once during pregnancy.

* Seventy-four percent of the cases occurred in mothers who were untreated, had inadequate treatment, or did not have documented treatment. Fourteen percent occurred in mothers who were adequately treated but did not have an adequate serologic response to therapy, and the infant was inadequately evaluated for congenital syphilis. Nine percent occurred in mothers who did not have an adequate serologic response to treatment and the infant's evaluation revealed signs of congenital syphilis. The remaining cases occurred in other situations.

* The rates of congenital syphilis declined in the South by 29%, and decreases occurred in all regions of the country except the Northeast. The rate of congenital syphilis declined 51% among American Indian/Alaska Native infants, 22% among Hispanic infants, 21% among Asian/Pacific Islander infants, and 20% among non-Hispanic black infants. There was no decline among non-Hispanic white infants.

* In 2002, 18 of the infants with congenital syphilis were stillborn and 8 died within 30 days of delivery.

BY TIMOTHY F. KIRN

Sacramento Bureau

COPYRIGHT 2004 International Medical News Group
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