(P11) CONGENITAL SYPHILIS AVERTED: TREATMENT INTERVALS OF PREGNANT PERSONS WITH SYPHILIS AND OPPORTUNITIES FOR PREVENTION, MARICOPA COUNTY, ARIZONA, 2022

Background:
Syphilis is an ongoing threat to reproductive health and infant well-being. Arizona has consistently reported rates of congenital syphilis (CS) higher than the national average. This study leverages the CS prevention cascade to identify missed opportunities to prevent vertical transmission of syphilis in Maricopa County, Arizona.

Methods:
Syphilitic pregnancies reported in 2022 were extracted from the Arizona STD surveillance database (PRISM). Pregnancies were followed from the last menstrual date until delivery. Mothers with an unpaired infant or re-infection during pregnancy were excluded from analysis. Time from maternal diagnosis to treatment initiation, maternal diagnosis to infant date of birth, maternal treatment initiation to infant date of birth, and infant outcome were of interest.

Results:
214 syphilitic pregnancies were included for analysis. During the study period, 55% (n=118) of potential CS cases were averted. Timeliness measures among mothers of averted infants and CS cases were discrepant; median days between diagnosis and treatment initiation (averted: 8; CS: 12), diagnosis to infant date of birth (averted: 184.5; CS: 1), and treatment initiation to infant date of birth (averted: 162.5; CS: 18). Among CS cases, missed opportunities for prevention were late diagnosis 64.6% (n=62), late treatment initiation 14.6% (n=14), inadequate treatment 9.4% (n=9), untreated 9.4% (n=9), and signs and symptoms despite adequate treatment 2.1% (n=2). When removing mother and infant pairs with a late diagnosis or signs and symptoms despite adequate treatment (n=64), 78.7% (n=118) of infants were successfully averted. Actionable missed opportunities therefore include late treatment initiation 43.8% (n=14), inadequate treatment 28.1% (n=9), and untreated 28.1% (n=9).

Conclusion:
Approximately half of all potential CS cases were averted when evaluating the CS prevention cascade. When assessing actionable prevention opportunities, 3 out of 4 infants were successfully averted. Late diagnosis underscores the need for greater uptake of prenatal care that includes syphilis screening and treatment early in pregnancy.