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Increased Reporting of Infants Born With Congenital Syphilis to a Local Department of Public Health: A Quality

John M Flores1,2,3, Allyson Dewey4, Brett K Palama2

  • 1Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.

Open Forum Infectious Diseases
|October 27, 2025
PubMed

Insights

Congenital syphilis (CS) reporting is improved by a new intervention. This quality improvement project enhanced case detection, including infants with nonreactive rapid plasma reagin (RPR) tests, boosting public health surveillance.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Congenital syphilis (CS) is a significant public health issue.
  • Current reporting methods may undercount CS cases, especially when infants test nonreactive for rapid plasma reagin (RPR) due to incomplete maternal treatment.
  • Delayed infant antibody seroconversion can also lead to underreporting.

Purpose of the Study:

  • To analyze CS cases and implement a quality improvement project to enhance reporting.
  • To address limitations in current CS surveillance, particularly concerning RPR-negative cases.

Main Methods:

  • A retrospective analysis of CS cases at a children's hospital (2011-2022).
  • Implementation of a prospective intervention (Sept 2023-Feb 2025) focusing on multidisciplinary communication, standardized electronic medical record entry, and regular reminders.
  • Evaluation of reporting rates before and after the intervention.

Main Results:

  • Before the intervention, 107 of 154 (69.4%) infants meeting CS criteria and receiving penicillin were RPR-negative and unreported.
  • Following the intervention's first cycle, 15 of 44 (34.1%) reported RPR-negative CS cases were successfully identified and reported.
  • The intervention significantly improved the reporting of CS cases, including those without RPR positivity.

Conclusions:

  • RPR-based reporting has limitations for accurate CS surveillance.
  • The quality improvement intervention effectively enhanced the reporting of congenital syphilis cases.
  • Improved reporting strengthens public health surveillance for congenital syphilis.
Abstract

Keywords:
congenital syphilisinfantpublic healthpublic health surveillancequality improvement

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