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Poster Session I: Congenital Syphilis & Syphilis in Pregnancy

(P18) A MULTIPLE CASE REVIEW TO EXAMINE CARE GAPS AND CRITICAL MISSED INTERVENTION AREAS TO ADDRESS CONGENITAL SYPHILIS AND INFANT HIV PREVALENCE IN NEW JERSEY

Tuesday, September 17, 2024
4:15 PM - 5:15 PM EST
Background:
Between 2020-2023, there were 2398 cases of syphilis among women of childbearing age (15-45) in New Jersey (NJ). Over the past three years, there has been an 80% increase in reported congenital syphilis (CS) cases in NJ. CS, while preventable, requires patients to begin Bicillin treatments at least 30 days prior to delivery. Disparities in healthcare and structural racism have possibly contributed to higher rates of CS in Hispanic and non-Hispanic Black populations. Patients have reported experiencing stigma of perceived drug use during pregnancy, lack of healthcare coverage and economic burden.

Methods:
This multiple case review included eight cases of mothers with syphilis (n=4) and HIV (n=4) and potential infant infection. Maternal syphilis and HIV cases were reported between 2020-2023. Each case was abstracted using Fetal Infant Mortality Review (FIMR) abstraction methodology. Cases were categorized into three risk groups (low, medium, or high) depending on level of missed opportunities and compared.

Results:
Mothers were between 22-43 and were 75% Black, non-Hispanic. Of mothers with HIV, 75% knew about their diagnosis prior to pregnancy while all mothers with syphilis were diagnosed in the third trimester and did not complete treatment before birth. When ranked, two HIV positive mothers were classified as low, one as medium, and one as high risk. Of syphilis positive mothers, two cases were medium risk and two were low risk.

Conclusion:
Previous research suggests significant differences between prenatal and postnatal care for potential HIV positive infants and CS infants. Case management does not occur equitably for syphilis positive mothers and improvements to existing services, with increased focus on CS prevention, could be instrumental in decreasing cases. Additional testing may provide earlier opportunity for adequate syphilis treatment and therefore improve case management.