(30) The Resurgence of Congenital Syphilis in Franklin County, Ohio

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

Background: Congenital syphilis remains a major public health problem resulting in substantial fetal and neonatal morbidity and mortality worldwide. In the United States, syphilis in women increased by 179% from 2015 to 2019, by 15% from 2019 to 2020, and by 36% from 2020 to 2021. Similarly, congenital syphilis has risen 254% relative to 2016 with 2268 reported cases in 2021. Ohio, and specifically Franklin County that includes Columbus, has experienced a substantial increase in congenital syphilis cases.

Objectives: 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 (CPH) in 2021 and the number of cases reported since 2003 using the CDC surveillance definition. 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; Tables 1, 2) 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) and 72% (n=13/18) had no prenatal care. 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. So far in 2022, there have been 20 cases of congenital syphilis reported to CPH.

Conclusion: Congenital syphilis has increased dramatically in Franklin County, Ohio and was associated with maternal illicit drug use. Due to inadequate prenatal care, high risk pregnant women should be tested for syphilis at any and all health care encounters in order to prevent congenital syphilis.