Characteristics Associated With Breakthrough Congenital Syphilis in Florida and Arizona, 2018-2022

Area of Science:

• Infectious Diseases
• Maternal-Fetal Medicine
• Public Health

Background:

• Congenital syphilis (CS) remains a significant global health concern.
• Breakthrough CS, occurring despite maternal syphilis identification and treatment, highlights challenges in prevention.
• Understanding risk factors for breakthrough CS is crucial for improving infant outcomes.

Purpose of the Study:

• To investigate maternal characteristics associated with the prevalence of breakthrough congenital syphilis.
• To identify specific maternal syphilis indicators linked to treatment failure resulting in CS.

Main Methods:

• Retrospective analysis of maternal and infant data for congenital syphilis cases.
• Examination of maternal syphilis stage (primary/secondary, latent, tertiary).
• Correlation of maternal non-treponemal antibody titers and timing of treatment initiation with CS outcomes.

Main Results:

• Maternal primary/secondary syphilis diagnosis was associated with a higher prevalence of breakthrough CS.
• Elevated maximum non-treponemal antibody titers in mothers correlated with increased CS risk.
• Initiating maternal syphilis treatment closer to the delivery date significantly increased the likelihood of breakthrough CS.

Conclusions:

• Maternal syphilis stage, viral load (indicated by titer), and treatment timing are critical factors in breakthrough CS.
• Timely and adequate maternal treatment may not always prevent CS, especially in cases of early syphilis stages or high titers.
• Further research into optimal treatment protocols and monitoring strategies is warranted to reduce congenital syphilis transmission.