Addressing the Crisis of Congenital Syphilis – An Evaluation of The Management of Syphilis in Pregnancy and The Newborn

Abstract

Objectives: Syphilis in pregnancy resulting in congenital syphilis (CS) is a growing public health crisis throughout Australia and in other high-income countries. This study aimed to evaluate the management of syphilis in pregnant women and their infants to identify opportunities to optimize care. Methods: A retrospective audit of public health notifications, clinical records and testing results between 2016-2018 was performed at ten hospitals across South-East Queensland, Australia. Management of each mother/infant pair was analyzed according to contemporary Australasian Society of Infectious Disease, Communicable Diseases Network Australia and United States Centers for Disease Control guidelines. Aspects assessed included maternal treatment and monitoring in pregnancy, partner treatment, investigations at delivery and infant treatment and monitoring. Results: Thirty women had positive syphilis serology in pregnancy requiring treatment. 97% women were diagnosed on initial testing with the timing of these tests spread equally across the 3. Documentation of partner testing and/or treatment was available for 47% women. See Table 1. 73% of women had treatment consistent with guidelines (i.e., stage-appropriate penicillin regimen completed greater than 4 weeks before delivery). 28/30 women received antibiotic treatment with penicillin. Four women, all diagnosed after 35 weeks gestation, did not complete treatment more than 4 weeks before delivery. Of 18 women treated for late latent syphilis, 3 had antibiotic dosing intervals greater than the recommended 7 days. No woman had the recommended monthly serology following treatment. Of 26 mother/infant pairs with complete data, 62% had investigations at delivery consistent with recommendations (i.e., RPR, placental histopathology and syphilis PCR, infant syphilis IgM and clinical examination). Four infants received additional investigations (i.e., blood tests, long bone X-rays or syphilis testing on CSF). One infant met criteria for confirmed CS (positive placental PCR) and was treated with appropriate IV benzylpenicillin. Four other infants were also treated. Of the 7 infants of mothers with inadequate antibiotic treatment in pregnancy, 2 received additional investigations and 3 received antibiotics at birth. Only 27% of infants had follow-up testing. Conclusions: Syphilis in pregnancy is a growing, worldwide public health concern. This audit identified several gaps in management that could be addressed including timely maternal testing and treatment, thorough partner screening and treatment, strict adherence to seven-day penicillin dosing for late latent syphilis, comprehensive maternal testing post-treatment and at delivery and infant testing at delivery and follow-up. Additionally, consideration must be given for infant management based on adequacy of maternal treatment in pregnancy. [Formula presented]L20166022752022-03-28 <br />