476 - Congenital Syphilis Cases in the Military Health System: A five-year review.

Publication Number: 3460.476

Isabel C. Elliott, Naval Medical Center San Diego, San Diego, CA, United States; Laura Kingkade, Naval Medical Center San Diego, San Diego, CA, United States; Ella Perrin, Naval Hospital Okinawa, Durham, NC, United States; Austin Baumeister, Naval Medical Center San Diego, San Diego, CA, United States; Daniel Jeziorski, US Navy, Huntsville, AL, United States; Nanda Ramchandar, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, San Diego, CA, United States; Shauna L. Stahlman, Defense Health Agency, Silver Spring, MD, United States

Background: The incidence of congenital syphilis (CS) is increasing worldwide, including in resource-rich settings, despite the availability of effective diagnostic and treatment strategies. This resurgence has significant implications for infant morbidity, mortality, and long-term development. Between 2012 and 2022, the rate of maternal syphilis among Military Health System (MHS) beneficiaries rose by 233%, accompanied by a 355% increase in congenital syphilis among newborns over the same period. Active-duty service members demonstrated consistently higher rates of maternal syphilis compared to non-service-member MHS beneficiaries. This increase in cases in the MHS paralleled national trends. We performed a detailed five-year review of CS cases in the Military Health System.

Objective: The purpose of this chart review is to determine who in the MHS received a complete workup and, if needed, received proper treatment according to the Red Book. Infant testing and treatment were also examined while comparing rates between traditional and reverse sequence pathways.

Design/Methods: MHS cases with a diagnosis of congenital syphilis between January 2018 and December 2022 were identified for analysis by ICD codes. Incomplete or missing charts were excluded, leaving 60 charts analysis (n=60). Maternal charts were reviewed for testing results and treatment information. Infant charts were reviewed to evaluate testing, treatment, and possible sequelae.

Results: Among the infants reviewed, 51% were classified in the "possible" category, 10% were classified as "highly probable", and 19% as "unlikely." The remaining 20% fell into the "less likely" category. Of infants in the "possible" category, only 24% received a complete workup, compared to 75% of "highly probable" infants. Only 52% of "possible" infants received adequate treatment, whereas 100% of "highly probable" infants were treated correctly. Fewer than 50% of patients had follow up serologic testing at their 2-month well-baby visit; 68% received testing at least once, 22% were tested at two follow-ups, and only 10% completed testing at all three recommended visits.

Conclusion(s): Congenital syphilis continues to present significant challenges in timely diagnosis and standardized management. Our review highlights gaps in follow-up care, incomplete diagnostic evaluations, and variability in treatment practices across risk groups. Further research is needed to evaluate factors contributing to incomplete evaluation, treatment, and follow-up; and to develop strategies to improve adherence to existing guidelines.

Treatment Accuracy
Total infants risk stratified into each category compared to those accurately treated.

Testing at Follow Up
Infants receiving testing at follow up appointments and proportion of those who were nonreactive at those follow ups.