WIP 78 - Congenital Syphilis: An Underestimated Problem

Publication Number: WIP 78.7444

Storm A. Dorrough, Children's Hospital of Wisconsin, milwaukee, WI, United States; Claudia Vicetti Miguel, Medical College of Wisconsin, Wauwatosa, WI, United States; Brittany Player, Medical College of Wisconsin, Wauwatosa, WI, United States; Kelsey Ryan, Medical College of Wisconsin, Milwaukee, WI, United States; Jared Boon, Medical College of Wisconsin, Milwaukee, WI, United States; Melodee Liegl, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Amy Pan, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Syphilis rates have risen drastically in the U.S. during the past decade, with congenital syphilis increasing 530% from 2016 to 2022. In Wisconsin, congenital syphilis cases reported annually increased >1000% from 2020 to 2023. Diagnosis of congenital syphilis is challenging - most affected infants are asymptomatic at birth and serologic tests lack sensitivity and specificity. The American Academy of Pediatrics (AAP) has risk-stratified guidelines for the management of infants born to a parent with a positive syphilis test during pregnancy. Data on adherence to this guidance is limited, and misinterpretation can lead to an altered treatment course representing under- and overtreatment.

Objective: To assess adherence to AAP guidance in the evaluation and treatment of infants at-risk for congenital syphilis at our institution and determine the impact on treatment course. We hypothesize that most instances of non-adherence resulted in altered treatment course.

Design/Methods: This IRB approved retrospective study includes infants 0-60 days old at risk for congenital syphilis admitted at a large perinatal Level IV Birth Center (>4000 births per year) and adjacent free-standing children’s hospital (298 total beds, Level IV NICU) between 01/01/2016-12/31/2023. Data collected from infants’ records includes demographics, exam findings, diagnostic data, treatment, follow-up testing, infectious disease consult, and outpatient specialty referral. Maternal data on syphilis diagnosis, serial non-treponemal test results and treatment were also collected. Laboratory and treatment data will be confirmed with the Wisconsin Department of Health reportable disease records. Adherence to AAP guidance will be defined as correct risk stratification and corresponding treatment course. Patterns of guidance deviation will be characterized, as these findings could inform improvement initiatives.