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, <10 prenatal visits, and maternal nontreponemal titer ≥1:8
increased the likelihood of a dead case; risk of a dead case increased with maternal
nontreponemal titer (χ2 for trend P < .001). Infants with CS born alive at <28 weeks’ gestation (relative risk, 107.4;
P < .001) or born weighing <1500 g (relative risk, 43.9; P < .001) were at greatly increased risk of death.
Conclusion
CS remains an important preventable cause of perinatal morbidity and mortality, with
comparable case fatality ratios during 1999 through 2013 (6.5%) and 1992 through 1998
(6.4%). Detection and treatment of syphilis early during pregnancy remain crucial
to reducing CS morbidity and mortality.
Key words
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Article info
Publication history
Published online: October 12, 2015
Accepted:
October 6,
2015
Received in revised form:
September 30,
2015
Received:
June 26,
2015
Footnotes
Dr Brooks was supported by the Centers for Disease Control and Prevention (CDC) Experience Fellowship, which had no involvement in this analysis. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
The authors report no conflict of interest.
Cite this article as: Su JR, Brooks LC, Davis DW, et al. Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013. Am J Obstet Gynecol 2016;214:381.e1-9.
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