(P430) How did Congenital Syphilis case characteristics change between 2018 and 2021 in Louisiana, a high morbidity state in the US?

Background: From 2012-2018, Louisiana ranked in the top 3 nationally for Congenital Syphilis (CS) case rates. Case counts and rates remained steady through 2018. Since 2018, case counts and subsequent rates have increased. We assessed the percent change in case characteristics accompanying the increase in CS cases.

Methods: We reviewed all CS cases and pregnant women with syphilis aged 15-45 years from 2018-2021 in Louisiana. We assessed the following demographic characteristics of the mothers of CS cases including: age, race/ethnicity, syphilis stage, syphilis titer, whether mother had at least 1 prenatal care visit within 32 weeks of pregnancy and location in Louisiana. We compared case characteristics in 2018 to 2021.

Results: Louisiana had a 40% increase in pregnant women with syphilis in 2021 (n=232) compared to 2018 (n=166). There was a 1.6 times increase in the CS case count (2021 n= 110, 2018 n=43) and 2.7 times increase in the CS rate (2021 = 191.7, 2018 = 72.1, per 100,000 live births).

Maternal syphilis stages were similar. In 2018, Primary/Secondary Syphilis (P&S) n=4 (9.3%), Early Latent (EL) n=18 (41.9%), Unknown / Late Latent (ULL) n=21 (48.8%) while in 2021 P&S n=11(10.0%), EL n=52 (47.3%), ULL n=47 (42.7%); CS cases in Blacks decreased by 23% (76.7% in 2018, 59.1% in 2021) while White CS cases increased by 65% (20.9% in 2018, 34.5% in 2021). CS case mothers age increased as 83.7% were aged 15-29 years in 2018 compared to 65.5% in 2021. Prenatal care decreased from 90.7% in 2018 to 81.8% in 2021. Mothers’ maximum titer during pregnancy was >1:4 in 62.8% in 2018 to 76.4% in 2021. Eighty-six percent were diagnosed by private providers in 2018 compared to 94% in 2021. Urban areas reported more cases in 2018 (New Orleans 23.3%, Baton Rouge 16.3% and Lafayette 14.0%) while in 2021 more cases were in rural areas (Alexandria 23.6%, Monroe 18.2% and Baton Rouge 17.3%).

Conclusion: The characteristics of mothers of CS cases in Louisiana were more likely to be older, from a more rural region and less likely to be Black in 2021.And, were less likely to have received prenatal care than in 2018.