(P1) DIVERGING PATHS? - EXPERIENCES OF SYPHILIS IN PREGNANT PERSONS LIVING WITH HIV

Background:
Congenital syphilis (CS) in the United States has increased dramatically in recent years while perinatal transmission of HIV reached a 5-year low in 2021. Using national CS data, we compared demographics, prenatal care, and missed prevention opportunities between pregnant persons with and without HIV.

Methods:
Using case-based CS data from all U.S. states, the District of Columbia, U.S. territories and freely associated states that were sent to CDC via the National Notifiable Diseases Surveillance System during 2018–2022, we compared region, race/ethnicity, prenatal care receipt, and missed CS prevention opportunities between pregnant persons with and without HIV.

Results:
During 2018–2022, 12,048 cases of CS were reported. Among these CS cases, 9,951 birth parents (82.6%) were HIV-negative, 149 (1.2%) were HIV-positive, and 1,948 (16.2%) had equivocal testing, or missing/unknown HIV status. Missing/unknown/equivocal HIV status was more likely in pregnant persons in the West (31.4%) compared to other regions (all <10.7%). Persons experiencing both syphilis and HIV during pregnancy lived disproportionately in the Northeast (2.2%) and South (1.8%). Birth parents reported as Black non-Hispanic were almost twice as likely to have HIV than the national average (2.2% of cases versus 1.2%). Missing/unknown/equivocal HIV status was more common in those with no versus at least one prenatal care visit (23.4% vs 12.2%), and among those with delayed or no syphilis testing (24.3%) compared to those with any other missed prevention opportunity (all <12.9%).

Conclusion:
While a small proportion of CS outcomes occur in persons with HIV, persons experiencing both syphilis and HIV in pregnancy are disproportionately represented in the Northeast and South, and among Black, non-Hispanic birth parents. Lack of prenatal care and of timely syphilis testing are often found in persons with unknown or missing HIV status. Greater linkage of syphilis and HIV testing in pregnancy may lead to improved diagnosis of both.