Evaluation of the Electronic Health Record as a Tool for Maternal and Congenital Syphilis Surveillance

Early entry into prenatal care and timely syphilis diagnosis and treatment of pregnant women can prevent congenital syphilis (CS). We assessed syphilis testing and treatment for pregnant women and their infants using electronic health records (EHRs).

We extracted syphilis testing results from pregnancy episodes documented in EHRs for women seeking care at the Medical University of South Carolina health system during 2021-2022. Chart reviews confirmed syphilis diagnosis, stage, and treatment. We calculated percentages of pregnant women who were (1) screened for syphilis, (2) received abnormal (i.e., reactive) test results, (3) newly diagnosed with syphilis, and (4) adequately treated for syphilis before delivery. We assessed testing and treatment outcomes of infants exposed to maternal syphilis.

Among 12,959 pregnant women, 75% (n = 9708) had ≥1 syphilis test during pregnancy; 106 (1.1%) had ≥1 abnormal test. From chart reviews, 54 women (51%) with abnormal test results were newly diagnosed with syphilis. The remaining abnormal test results were false positives (n = 15) or previous diagnoses (n = 37). Forty-four (81%) new diagnoses were treated during pregnancy; 30 (56%) were treated >30 days before delivery. Fifty-six infants born to women with an abnormal syphilis test result were evaluated for CS, of whom 24 (43%) had abnormal test results and 18 (75%) were treated for CS.

Although EHRs could reliably assess syphilis testing during pregnancy, chart review and consultation with public health authorities were necessary to confirm adequate treatment and CS follow-up. Triangulating EHRs with other data sources could enhance the understanding of syphilis during pregnancy and inform CS prevention efforts.