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Congenital Syphilis Surveillance and Newborn Evaluation in a Low-Incidence State
Dawn L. Martin, MD, MPH;
Jolene R. Bertrand, BS;
Catherine P. McKegney, MD;
Linda R. Thompson, MD;
Edward A. Belongia, MD;
Wendy A. Mills, MPH
Arch Pediatr Adolesc Med. 2001;155:140-144.
Objectives To evaluate congenital syphilis surveillance in Minnesota, to assess
the evaluation and management of newborns at risk for congenital syphilis,
and to assess prenatal syphilis screening.
Design Case ascertainment and medical record review.
Setting The 7-county Minneapolis–St Paul metropolitan area.
Patients Newborns at risk for congenital syphilis during a 3-year period (1992-1994).
Main Outcome Measures The completeness of congenital syphilis case ascertainment, maternal
demographic data, maternal syphilis management, newborn evaluation for and
management of congenital syphilis, and hospital syphilis screening practices
at delivery.
Results Eighty mother-infant pairs who were at risk for congenital syphilis
were identified from 3 sources. Using the Centers for Disease Control and
Prevention's congenital syphilis case definition, 36 infants (45%) were classified
as probable cases, 42 (53%) were classified as noncases, and 2 (3%) were syphilitic
stillbirths. Forty-seven women (59%) had syphilis serologic tests performed
in the third trimester; only 37 (46%) had syphilis screening at delivery.
Conditions of the mothers of 8 probable cases (22%) were diagnosed at delivery.
Most probable cases (86%) were evaluated; only 56% were evaluated adequately.
Twenty-five probable cases (69%) were treated. Most hospitals did not have
formal policies for syphilis screening at delivery. The Minnesota Department
of Health's congenital syphilis registry lacked sensitivity (39%) as a case
ascertainment method.
Conclusions Clinicians should adhere to standardized protocols in the evaluation
and management of at-risk newborns. Vigilant screening prenatally and at delivery
and adequate follow-up are critical to reduce congenital syphilis. Improved
surveillance data and resources are needed for the identification and follow-up
of newborns at risk for congenital syphilis.
From the Departments of Pediatrics (Drs Martin and Thompson and Ms
Bertrand) and Family Practice (Dr McKegney), Hennepin County Medical Center,
the Minneapolis Medical Research Foundation (Ms Bertrand), and Minnesota Department
of Health (Ms Mills), Minneapolis, Minn; and Marshfield Medical Research Foundation,
Marshfield, Wis (Dr Belongia).
Corresponding author: Dawn L. Martin, MD, MPH, Department of Pediatrics,
MC 867B, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN 55415
(e-mail: dawn.martin{at}co.hennepin.mn.us).
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