Pregnant women with syphilis who do not receive a proper diagnosis and/or adequate prenatal care may spread the infection in utero to their fetuses. Congenital syphilis can have major health impacts, such as miscarriage, stillbirth, premature birth and low birthweight, as well as jaundice, meningitis, deformed bones and severe anemia in infants.
In a recent qualitative study of contributing factors in cases of congenital syphilis reported in the state of Indiana, all instances were found to be attributable to maternal social or behavioral influences that can hamper women’s care, rather than affected by any missed opportunities by providers to follow accepted guidelines for screening and treatment. “Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014–2016,” published online ahead-of-print in the Journal of the American Sexually Transmitted Diseases Association, was led by Dawne DiOrio, adjunct instructor in the Epidemiology and Biostatistics Department at the School of Public Health and adjunct instructor in the undergraduate Health Care Management and Policy faculty group at School of Public and Environmental Affairs.
In collaboration with co-authors Karen Kroeger of the CDC and Amara Ross of the Indiana State Department of Health, DiOrio assessed maternal interviews and records regarding 23 congenital syphilis cases from Indiana that were reported to the CDC during 2014–2016, using qualitative methods to examine the effect various maternal social deprivation factors had on the cases of congenital syphilis under review. Although 21 of the 23 women in the study had health insurance, prenatal visits were below optimal limits, with more than a third of study subjects receiving no prenatal care at all. Most had a history of substance abuse, homelessness or incarceration. The sole risk factor for syphilis for almost one third was engaging in sex with a primary male partner.
The team concluded that some pregnant women with syphilis will not receive a timely diagnosis and treatment, despite healthcare providers adhering to state and CDC recommendations. Not only are additional support and resources required to prevent the exposure of fetuses to the disease among high-risk pregnant women, but also efforts need to be made to enlist the help of the male partners of pregnant women with syphilis.
“This research is the first of its kind to examine socioeconomic and behavioral factors among women giving birth to an infant with syphilis, and it makes several important recommendations for national health policy,” observes DiOrio,. Some recommendations from the research include: identifying pregnant women who have discontinued prenatal care in order to provide support for them to return to care, consideration of emergency department and urgent care syphilis testing for pregnant women not in prenatal care, earlier identification of syphilis infection in male partners of pregnant women, expanded use of the syphilis point-of-care rapid test, and strengthening local links in the social and health safety net.