320 - The Dramatic Resurgence of Congenital Syphilis in Franklin County, Ohio

Poster Number: 320
Publication Number: 320.124

Rachel Graf, Ohio State University College of Medicine, Columbus, OH, United States; Manish Rijal, Nationwide Children's Hospital, Columbus, OH, United States; Charles Miller, Columbus Public Health, Columbus, OH, United States; Traci Pifer, Nationwide Children's Hospital, Columbus, OH, United States; Jose A. Bazan, Ohio State University College of Medicine, Columbus, OH, United States; Tanisha R. Pettus, Columbus Public Health, Columbus, OH, United States; Stephen F. Thung, Ohio State University College of Medicine, New Albany, OH, United States; Maged Costantine, Ohio State University College of Medicine, Columbus, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Background: Congenital syphilis remains a major public health problem resulting in substantial fetal ad neonatal morbidity and mortality worldwide. In the United States, syphilis in women has increased dramatically by 179% since 2015–2019. Similarly, congenital syphilis has risen 291% relative to 2015. Ohio, and specifically Franklin County, which includes Columbus, has experienced a substantial increase in congenital syphilis cases.

Objective: To review the cases of maternal/infant syphilis in Franklin County, Ohio and describe associated factors that could aid in the prevention of congenital syphilis

Design/Methods: Retrospective cohort study of congenital syphilis cases reported to the Columbus Public Health Department (CPH) in 2021 and the number of cases reported since 2003 using the CDC surveillance definition. Pertinent demographic, clinical, laboratory, and radiographic data were obtained from maternal reports as well as infants’ electronic health records.

Results: Congenital syphilis in Franklin County has increased since 2007 when no cases were reported to the Ohio Department of Health and CDC (Figure 1). In 2021, there were 19 cases (1 set of twins) of congenital syphilis reported to CPH, signifying a 375% increase from the 4 cases reported in 2020. Of the 19 congenital syphilis cases, 2 were stillborn (one at 28 weeks had nonimmune hydrops) for a case fatality rate of 11%. All mothers had untreated or inadequately treated syphilis. The majority of mothers were white (67%, n=12) with 22% (n=4) Black, 6% (n=1) Hispanic, and 1 not known. 72% (n=13/18) of mothers had no prenatal care, although 11% (n=2/18) had ≥3 prenatal visits. Fifteen (83%) of the 18 mothers used illicit drugs (11, fentanyl; 10, cocaine; 5, heroin; 4, methamphetamine) including the mother of 1 stillborn infant. The 17 liveborn infants had a mean (±SD) gestational age of 36 ± 3 weeks and birth weight of 2612 ±740 grams (41% [7/17] were < 2500 grams). Of the 17 liveborn infants, only 1 (6%) had an abnormal physical examination while 2 (12%) had abnormal bone radiographs consistent with congenital syphilis. Ten (59%) of the 17 infants received treatment with intramuscular benzathine penicillin G. Conclusion(s): In 2021, congenital syphilis increased dramatically in Franklin County, Ohio and was associated with maternal illicit drug use. Given the lack of adequate prenatal care in the majority of cases, high risk pregnant women should be tested for syphilis at any and all health care encounters so that timely diagnosis and treatment before delivery can be achieved, and congenital syphilis can be prevented.
Rachel Graf CVRachel Graf CV.pdf