Missed opportunities for congenital syphilis prevention in an urban southeastern hospital

Background: Despite recent declines in syphilis rates nationally, recent ou tbreaks suggest that prevention of congenital syphilis remains an ongoing p ublic health problem. Goals: To identify missed opportunities for congenital syphilis prevention during prenatal care. Study Design: Retrospective medical record review of 157 live birth or stil lbirth deliveries that involved cases of congenital syphilis from Grady Mem orial Hospital (Atlanta, GA). Results: The hospital congenital syphilis prevalence was 8.2 cases per 1000 live births. Six percent of case patients were EW positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cas es attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%, P = 0.01). Conclusion: Provider efforts to reduce congenital syphilis in high-risk pop ulations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the thir d trimester (i.e., 28 weeks); (2) performing on-site testing and same-day t reatment; (3) providing appropriate treatment to infected women with penici llin allergy; (4) referring sex partners for treatment to prevent reinfecti on; and (5) screening all pregnant women attending emergency clinics.