Congenital Syphilis in Chicago: An Analysis of Recent Cases

Abstract

Objective: Congenital syphilis (CS) occurs during pregnancy when maternal infection is not adequately treated in a timely manner. It can result in miscarriage, stillbirth, and multiple complications in the newborn including death. Since congenital syphilis is preventable, each case represents a public health missed opportunity. The incidence of congenital syphilis in the United States has been rising yearly since 2012. The purpose of this study is to analyze all congenital syphilis cases in Chicago from 2015 to 2019 using multiple data sources in order to determine in each case why the disease was not averted. This must be done in order to target resources appropriately and impact future cases. Methods: All probable congenital syphilis cases reported to the Chicago Department of Public Health (CDPH) from January 1, 2015 through December 31, 2019 were reviewed. Both quantitative and qualitative data were collected from multiple sources. Missed opportunities for preventing CS were determined for each case and classified as either patient, provider, or system factors. Data on causes were collected, summarized, and divided by year to look for trends over time. Results: There were 65 CS cases in the five years, with a majority occurring in non-Hispanic Black women in their 20s from communities with high levels of economic hardship. There was a steady decline in cases over time, from 24 in 2015 to 8 in 2019. Of these cases, 41 (63.1%) were attributed to patient factors, the most common being a lack of prenatal care in 27 (41.5% of all cases). Provider factors were responsible 17 (26.1%) of cases, including both testing and treatment errors. Systems factors were responsible for 7 (10.8%). Numbers were too small to make statements about changes in type of factor over time. Discussion: The incidence of CS cases in Chicago has decreased over the past 5 years, but there are marked disparities by both race and community. Lack of prenatal care is the single most common cause of CS, but provider errors and systems factors are responsible for a significant portion as well. In order to impact this disease, resources need to be focused on engaging at-risk communities in prenatal care as well as increasing education to providers and streamlining referral systems when necessary to effect treatment. A multi-level approach is necessary to eliminate CS in Chicago.

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