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

• Published in: American journal of obstetrics and gynecology 2016-03, Vol.214 (3), p.381.e1-381.e9
• Main Authors: Su, John R., MD, PhD, MPH, Brooks, Lesley C., MD, Davis, Darlene W, Torrone, Elizabeth A., PhD, Weinstock, Hillard S., MD, MPH, Weinstock, Mary L., MD, MPH
• Format: Article
• Language: English
• Subjects: Birth Weight; congenital syphilis; Female; Humans; Infant; infant mortality; Infant Mortality - trends; Infant, Newborn; Infant, Very Low Birth Weight; Infectious Disease Transmission, Vertical - prevention & control; Morbidity - trends; Obstetrics and Gynecology; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Premature Birth - epidemiology; prenatal care; Prenatal Care - statistics & numerical data; Risk Factors; sexually transmitted disease surveillance; stillbirth; Stillbirth - epidemiology; Syphilis, Congenital - epidemiology; Syphilis, Congenital - prevention & control; Syphilis, Congenital - transmission; United States - epidemiology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.10.007

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 nonserologic 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,