Multilevel Drivers of Congenital Syphilis, Oregon, 2013 to 2021.

Area of Science:

• Public Health
• Epidemiology
• Maternal Health

Background:

• Congenital syphilis (CS) cases are increasing in the US, including Oregon, despite available penicillin treatment.
• This trend highlights a critical gap in preventing prenatal syphilis transmission.

Purpose of the Study:

• To identify individual- and county-level predictors of congenital syphilis (CS) among pregnant individuals diagnosed with syphilis in Oregon.
• To inform targeted interventions for CS prevention.

Main Methods:

• Retrospective analysis of data from 2013-2021 in Oregon.
• Utilized surveillance reports, County Health Rankings, and other county-level data sources.
• Employed multilevel Poisson regression models to assess risk factors.

Main Results:

• Of 343 pregnant individuals with syphilis, 95 (27.6%) had a case of CS.
• Individual factors: Injection drug use and corrections involvement increased CS risk; recent gonorrhea diagnosis decreased risk.
• County-level factors: Violent crime, unemployment, income inequality, and adverse childhood experiences increased CS risk, especially for those with corrections involvement.

Conclusions:

• Injection drug use, corrections involvement, and adverse county-level socioenvironmental factors significantly increase CS risk.
• Urgent public health interventions are necessary, including innovative care, policy reform, and community collaboration.
• Addressing systemic issues is vital to combat the escalating CS crisis.