CONGENITAL-SYPHILIS IN MARYLAND, 1989-1991 - THE EFFECT OF CHANGING THE CASE-DEFINITION AND OPPORTUNITIES FOR PREVENTION

Background: The reported incidence of congenital syphilis in the Unite d States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been pu blished regarding missed opportunities for prenatal intervention. Goal of this Study: To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congen ital syphilis incidence or a change in the surveillance case definitio n, and to describe missed opportunities for prenatal intervention. Stu dy Design: This was a retrospective cohort study. Results: When the re vised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mother s had received no prenatal care. Among those whose mothers had receive d prenatal care, opportunities to intervene were missed for 53%. Concl usions: Although a true increase in congenital syphilis incidence occu rred before 1990, the increase reported in Maryland between 1989 and 1 991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.