(P13) IMPLEMENTATION OF A PERINATAL SYPHILIS PROGRAM TO IMPROVE TREATMENT AND REDUCE CONGENITAL SYPHILIS IN A HIGH PREVALENCE REGION IN TEXAS

Background:
In Houston, Texas, there has been a 250% increase in congenital syphilis (CS) during 2022. This study aims to determine if the implementation of a perinatal syphilis program would improve treatment completion during pregnancy and reduce CS compared to a historical cohort of pregnant people with syphilis in Houston.

Methods:
In April 2022, a perinatal syphilis program was implemented at the University of Texas Health Science Center in Houston, where pregnant patients with syphilis undergo counseling with maternal-fetal medicine specialist, fetal sonographic evaluation, partner testing and treatment, and social work support services. Demographic and socioeconomic variables along with pregnant person and neonatal infection-related data were recorded and compared to a matched historical cohort of exposed dyads prior to program implementation. Univariate analysis was used to compare factors associated with treatment completion and CS. Results were reported as relative risk (RR) and 95% confidence intervals.

Results:
Fifty-nine pregnant people with syphilis were enrolled. Twenty-six (44%) were enrolled prior to implementation of the program (12/2017-03/2022) and 33 (56%) were enrolled after (05/2022-02/2023). In the pre-implementation program cohort, 30.8% (N=8) of pregnant people completed syphilis treatment, compared to 66.7% (N=22) in pregnant patients with syphilis after program initiation, demonstrating a RR of 2.17 (1.15-4.07). After excluding 8 neonates with unknown CS status, there was a >50% reduction in CS after the program was started [84.6% vs. 40.0% pre- and post-respectively; RR 0.47 (0.28-0.79)]. Factors significantly associated with lack of treatment completion and CS were psychiatric disorders, lack of prenatal care, and a preferred language other than English (p = <0.001, 0.007, and 0.04, respectively).

Conclusion:
The implementation of a perinatal syphilis program focused on patient-centered care significantly improved treatment completion during pregnancy and reduced CS. Targeted efforts focused on barriers surrounding mental health and health care access for pregnant underserved populations with syphilis should be prioritized.