Promising Approaches to the Congenital Syphilis Health Crisis

January 30, 2024 | Julia Greenspan

Cases of congenital syphilis have exploded in recent years, increasing over 10X since 2012 and more than doubling in the last five years. Although there is an increasing number of congenital syphilis cases in the United States, it is an easily preventable disease.

Congenital syphilis occurs when a pregnant person has untreated syphilis and passes the infection on to their child. Forty percent of exposed babies will be stillborn or die soon after birth, and those who survive face permanent physical and neurological effects. With timely identification and treatment of syphilis in pregnant people and a comprehensive approach to preventing future cases, congenital syphilis could be eliminated.

ASTHO has worked closely with CDC and some of its Strengthening STD Prevention and Control for Health Departments grantees to highlight innovative sexually transmitted infections (STIs) treatment and prevention approaches that jurisdictions have implemented. This blog highlights tools and strategies from four grantee programs that have focused on identifying syphilis in people who are pregnant or could become pregnant.

Improving Lab Reporting of Pregnancy Status for People with Syphilis

The New York City Department of Health and Mental Hygiene worked with laboratories to record timely and accurate pregnancy status ascertainment. Lab reporting of pregnancy status, if known and indicated, is required in most states for people with certain infectious diseases. One method of improving the timely ascertainment of pregnancy status is requiring labs to report when pregnancy is probable, which can lead to more efficient intervention and case management for syphilis cases. The city health department leveraged new health code amendments to increase the collection of probable and confirmed pregnancy status from labs among individuals infected with certain diseases, including syphilis.

Enhancing Congenital Syphilis Prevention with Education and Surveillance Alerts

The New York state Congenital Syphilis Prevention Program (login required) is a comprehensive approach to reducing congenital syphilis missed prevention opportunities and reducing failures of public health and healthcare systems that lead to congenital syphilis. Some of the components of the program include a clinical education initiative that exists as a resource for disease intervention specialists and clinicians, and a surveillance alert system to ensure possible congenital syphilis cases are investigated in a timely fashion.

“Though syphilis was virtually eliminated in New York state in the early 2000s, diagnoses have increased almost every year since then. Of particular concern is the increase seen among persons of childbearing capacity and the subsequent impact on the rise of syphilis among infants (congenital syphilis). As every case of congenital syphilis is entirely preventable, the increases we are seeing represent a lack of access or appropriate healthcare.”

Rachel Malloy, PhD, MPH, director of New York State Department of Health’s Office of Sexual Health and Epidemiology, on how cases of syphilis and congenital syphilis have grown in recent history.

Creating a Critical Task List to Improve Pregnancy Status Reporting

The Florida Department of Health developed a low-resource intervention called the Critical Task List to improve the timely reporting of the pregnancy status of people with syphilis. The Critical Task List is a weekly automated email alert sent to program managers, regional coordinators, and state-level staff highlighting STI records missing key data. Over time, this tool enabled the state to achieve nearly 100% of female syphilis diagnosis cases to include data on pregnancy status, and it aided STI programs in prioritizing cases for disease intervention specialist follow-up. follow-up.

Automating Syphilis Electronic Laboratory Processing

The Florida Department of Health created an algorithm to automate syphilis laboratory result processing, allowing the health department to improve case assignment accuracy and prioritization. By improving the efficiency of processing syphilis lab results, priority results can be more easily identified and assigned for investigation and follow-up. The algorithm filters out potential cases from likely biological false positives and non-cases, and it adjusts the amount of time a test is held to determine if a non-treponemal test was completed based on childbearing capacity and age.

Although congenital syphilis rates are a growing concern, many jurisdictions have created new and innovative approaches to identify and treat syphilis cases among pregnant people and people of childbearing capacity. To learn more about the programs outlined above, access ASTHO’s learning tools on strengthening STD prevention and control for health departments.

This publication was supported by the Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health OT18-1802 Cooperative Agreement, funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.