Thirty-seven cases of congenital syphilis were reported among
newborns in Texas during 1981. An increase of 164% over the 14
cases
reported in 1980, this represents the highest number since 1971
when
52 cases were reported. Reported cases of early syphilis among
women
in Texas increased 47.3% from 2,024 in 1980 to 2,982 in 1981.
Data submitted with each congenital syphilis case were
reviewed,
and cases were classified according to the diagnostic criteria of
Kaufman et al. (1). No case was classified as definite; 25 (67.6%)
were classified as probable, based on serologic evidence and
clinical
findings; eight (21.6%) as possible, based on serologic evidence
alone; and four (10.8%) as unlikely. The unlikely cases for which
the
diagnosis appeared to be based solely on evidence of maternal
infection at delivery time have been excluded from the analysis
that
follows.
Of 33 infants evaluated, five (15.2%) were white, not of
Hispanic
origin; 16 (48.5%) were black, not of Hispanic origin; and 12
(36.4%)
were Hispanic. Fourteen were male and 19, female. Thirty-one were
live births, and two were stillborn. Two infants died within 6
days
of delivery; prematurity was listed as contributing to both deaths.
The mean age of the 33 mothers was 21.7 years. Ten (30.3%)
were
15-19 years; none of those was married. Among all 33 mothers,
seven
were married; three were separated; and 23 were single. The stage
of
the mother's infection at delivery time was primary or secondary in
eight instances (24.2%) and early latent 1 year in 23 (69.7%); two
patients (6.1%) had late syphilis.
Twenty-five of the 33 mothers received no prenatal care. Of
the
eight who received prenatal care, five began seeing a physician
late
in the third trimester, and three who had negative results of
serologic tests for syphilis (STS) during the first trimester did
not
have a repeat STS in the third trimester.
Reported by R Pelosi, Infectious Disease Control Div, CD Alexander,
MD, Bureau of Communicable Disease Svcs, CR Webb, Jr, MD, State
Epidemiologist, Texas Dept of Health; Veneral Disease Control Div,
Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Congenital syphilis is completely preventable.
Its
development can be related to two factors: when the pregnant woman
becomes infected and how long she remains infected. Detection of
untreated syphilis before delivery and prompt administration of
appropriate therapy can often prevent congenital infection and can
usually prevent complications among fetuses infected in utero.
Congenital syphilis can be eliminated or greatly reduced by: 1)
preventing the spread of syphilis in the heterosexual community
through rapid and thorough epidemiologic investigations; 2)
educating
females at risk of infection about the need to seek early and
continuous prenatal care; and 3) encouraging medical care providers
to
perform serologic tests for syphilis on patients in the third, as
well
as the first, trimester.
References
Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire
survey
of reported early congenital syphilis: problems in diagnosis,
prevention, and treatment. Sex Transm Dis 1977;4:135-9.
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