(P432) Social Vulnerabilities Associated with Congenital Syphilis

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

AR

Aditi Ramakrishnan, MD, MSc

Assistant Professor of Medicine, Division of Infectious Diseases
Washington University in St. Louis, School of Medicine, United States
Hilary Reno, MD, PhD

Professor, Division of Infectious Diseases
Washington University in St. Louis, School of Medicine
Saint Louis, Missouri, United States

Co-Author(s)

ED

Elizabeth A. Daniels, MD

Pediatric Infectious Disease Fellow
Washington University in St. Louis, School of Medicine
St. Louis, Missouri, United States

Co-author(s)

NC

Nicholas Cardoza, BS

Developer, Public Health Training and Data Center
Institute for Public Health, Washington University in St. Louis, United States
DW

Denise Willers, MD

Associate Professor, Obstetrics and Gynecology
Washington University in St. Louis, School of Medicine, United States

Background: Congenital syphilis (CS) is a preventable disease that disproportionately impacts certain racial groups and individuals with social vulnerabilities including substance use, homelessness, and incarceration. Understanding the social vulnerabilities associated with CS is critical both for the management of mothers and infants and for ensuring that they receive holistic care including appropriate social services.

Methods: We performed a retrospective review of potential cases of CS at a large hospital system in Missouri, which were classified per CDC case definitions. Information was collected regarding maternal race, adequacy of prenatal care, insurance and employment status, and histories of housing instability, substance use, sex work, and interactions with the prison system or Children’s Division (CD). Cases of confirmed/highly probable and possible CS were then compared to cases of less likely and unlikely CS via Chi Square analysis.

Results: We identified 81 mother-infant dyads, with infant dates of birth ranging from 12/21/2015-8/20/2021. This group included 44 cases of confirmed/highly probable or possible CS (54.3%) and 36 cases of less likely or unlikely CS (44.4%). One case could not be classified. Most mothers were Black, and a large proportion were unemployed and/or had a history of substance use. A minority had a history of interactions with the prison system (24.7%), sex work (8.6%), or homelessness/housing instability (24.7%). A CD hotline was placed at the time of delivery in almost half of CS cases, and infant custody was taken in 17.3% of cases. Infants with proven/highly probable or possible CS were more likely to have mothers with a history of suboptimal prenatal care, substance use, and a positive urine drug screen at delivery, and to have a CD hotline placed at the time of delivery.

Conclusion: Our analysis reaffirmed that social vulnerabilities are common in individuals impacted by CS. Although some factors are more common in cases of confirmed/highly probable or possible CS, notable vulnerabilities were often present in cases of less likely and unlikely CS. For example, CD involvement and loss of infant custody frequently occurred in both groups. Intensive social support is required for the prevention and management of CS.