(P3) MISSED OPPORTUNITIES FOR CONGENITAL SYPHILIS PREVENTION: FINDINGS FROM CALIFORNIA, 2020-2022

Background:
The 2022 rates of CS and adult syphilis in California were the highest they had been since 1950. We reviewed CS cases to determine missed opportunities for prevention and compared patterns by race/ethnicity and other known risk factors.

Methods:
We categorized California Project Area (all counties excluding Los Angeles and San Francisco) CS cases from 2020-2022 based on these mutually exclusive missed opportunities for CS prevention: no prenatal care (PNC), no syphilis testing at first PNC visit, inadequate treatment (i.e., beginning fewer than 30 days before delivery, incorrect dosing intervals, too few doses, or otherwise inappropriate), reinfection after treatment, no testing during early third trimester of pregnancy after initial negative test, and infection occurred after a third trimester syphilis test. We assessed these missed opportunities, stratified by race/ethnicity, methamphetamine use, and homelessness using Pearson’s chi-squared test.

Results:
From 2020-2022, there were 1,175 CS cases. Sixty-four percent (757) of birthing parents (BP) were diagnosed with syphilis before delivery. Of these 757, 45% (337) did not receive PNC, 20% (151) were not tested at first PNC visit, 15% (116) experienced treatment gaps, 12% (88) delivered infants with CS despite adequate maternal treatment, 5% (35) experienced reinfection during pregnancy, and 4% (30) were not tested during early third trimester. BP who used methamphetamine (42%, 317) and/or experienced homelessness (20%, 152) were more likely to have not received PNC (p < .05). White BP (29%, 217) were less likely to have received PNC (p < .05) than non-White BP. Hispanic BP (48%, 361) were more likely to have received PNC and be reinfected (p < .05) than non-Hispanic BP.

Conclusion:
There are missed opportunities at each step of CS prevention. Improving access to prenatal care, care in alternative settings, and timely screening, diagnosis, and treatment of syphilis during pregnancy may have the greatest impact on CS prevention.