Wednesday, December 6, 2023
| Characteristic | No. (%) | |||
|---|---|---|---|---|
| Congenital syphilis (n = 360) | Noncongenital syphilis (n = 410) | |||
| Any substance use (n = 173) |
No substance use (n = 187) |
Any substance use (n = 101) |
No substance use (n = 309) |
|
| Age, yrs, median (IQR) | 27.7 (23.4–31.9) | 26.3 (21.8–30.7) | 27.8 (23.8–31.3) | 25.3 (22.2–29.6) |
| Age group, yrs | ||||
| <25 | 55 (31.8) | 72 (38.5) | 37 (36.6) | 146 (47.2) |
| 25–29 | 59 (34.1) | 63 (33.7) | 31 (30.7) | 92 (29.8) |
| 30–34 | 37 (21.4) | 34 (18.2) | 25 (24.8) | 54 (17.5) |
| ≥35 | 21 (12.1) | 16 (8.6) | 8 (7.9) | 17 (5.5) |
| Missing/Not reported | 1 (0.6) | 2 (1.1) | 0 (—) | 0 (—) |
| Education level | ||||
| Less than high school | 51 (29.5) | 55 (29.4) | 30 (29.7) | 94 (30.4) |
| High school graduate or GED | 53 (30.6) | 50 (26.7) | 35 (34.7) | 113 (36.6) |
| Some college but no degree | 24 (13.9) | 35 (18.7) | 24 (23.8) | 59 (19.1) |
| College degree or more | 5 (2.9) | 23 (12.3) | 8 (7.9) | 22 (7.1) |
| Missing/Not reported | 40 (23.1) | 24 (12.8) | 4 (4.0) | 21 (6.8) |
| Insurance at delivery | ||||
| Public | 130 (75.1) | 91 (48.7) | 81 (80.2) | 164 (53.1) |
| Private | 12 (6.9) | 12 (6.4) | 6 (5.9) | 31 (10.0) |
| Other/None/Self-pay | 14 (8.1) | 10 (5.3) | 2 (2.0) | 12 (3.9) |
| Missing/Not reported | 17 (9.8) | 74 (39.6) | 12 (11.9) | 102 (33.0) |
| Prenatal care | ||||
| First/Second trimester | 78 (45.1) | 124 (66.3) | 79 (78.2) | 281 (90.9) |
| Third trimester | 26 (15.0) | 25 (13.4) | 13 (12.9) | 16 (5.2) |
| No care | 66 (38.2) | 35 (18.7) | 4 (4.0) | 3 (1.0) |
| Missing/Not reported | 3 (1.7) | 3 (1.6) | 5 (5.0) | 9 (2.9) |
| No. of prenatal visits, median (IQR) | 1 (0–6) | 6 (1–10) | 9 (6–11) | 10 (7–13) |
| Treatment | ||||
| Adequate§ | 26 (15.0) | 46 (24.6) | 101 (100) | 309 (100) |
| Inadequate¶ | 55 (31.8) | 62 (33.2) | NA | NA |
| Not treated during pregnancy¶ | 92 (53.2) | 79 (42.2) | NA | NA |
| History of incarceration** | ||||
| Yes | 28 (16.2) | 6 (3.2) | 11 (10.9) | 5 (1.6) |
| No | 70 (40.5) | 102 (54.5) | 63 (62.4) | 181 (58.6) |
| Missing/Not reported | 75 (43.4) | 79 (42.2) | 27 (26.7) | 123 (39.8) |
| History of homelessness** | ||||
| Yes | 46 (26.6) | 2 (1.1) | 9 (8.9) | 3 (1.0) |
| No | 70 (40.5) | 106 (56.7) | 71 (70.3) | 190 (61.5) |
| Missing/Not reported | 57 (32.9) | 79 (42.2) | 21 (20.8) | 116 (37.5) |
Table 1. Characteristics of pregnant persons with syphilis, by reported substance use* and congenital syphilis pregnancy outcome† (N = 770) — Surveillance for Emerging Threats to Pregnant People and Infants Network, Arizona and Georgia, 2018–2021
Abbreviations: CSTE = Council of State and Territorial Epidemiologists; GED = general educational development certificate; NA = not applicable.
*Any substance use includes any use of tobacco (e.g., cigars, cigarettes, smokeless tobacco, or e-cigarettes), alcohol, cannabis, illicit use of opioids (e.g., prescription opioids not taken as prescribed, fentanyl, or heroin), and other illicit, nonprescription substances (e.g., cocaine, methamphetamines, inhalants, or hallucinogens, such as LSD or PCP).
†Congenital syphilis pregnancy outcome includes pregnancy outcomes that meet the CSTE surveillance case definition for syphilitic stillborn or live-born infant with probable or confirmed congenital syphilis.
§Adequacy of treatment dependent on syphilis stage. Primary, secondary, and early latent syphilis require at least 1 dose of penicillin during pregnancy, with the dose administered ≥30 days before pregnancy outcome. Late latent, latent of unknown duration, tertiary, and other cases of syphilis require ≥3 doses of penicillin, spaced 5–9 days apart, with the first dose administered ≥30 days before delivery and the final dose administered during pregnancy.
¶Stillborn and live-born infants born to pregnant persons inadequately treated or not treated during pregnancy meet the CSTE case definition for a probable congenital syphilis pregnancy outcome.
**Within the 12 months preceding case report or positive test results or during pregnancy.
| Substance used | No. (%) | Prevalence ratio¶
(95% CI) |
|
|---|---|---|---|
| Congenital syphilis (n = 360) |
Noncongenital syphilis (n = 410) |
||
| Any substance* | 173 (48.1) | 101 (24.6) | 1.95 (1.60–2.38) |
| Tobacco | 99 (27.5) | 46 (11.2)** | 2.45 (1.78–3.37) |
| Alcohol | 29 (8.1) | 20 (4.9)** | 1.65 (0.95–2.86) |
| Cannabis | 69 (19.2) | 56 (13.7)†† | 1.40 (1.01–1.93) |
| Illicit use of opioids§§ | 75 (20.8) | 14 (3.4)** | 6.09 (3.50–10.58) |
| Illicit, nonprescription substance¶¶ | 101 (28.1) | 26 (6.4)** | 4.41 (2.94–6.63) |
Table 2. Reported substance use*,† among pregnant persons with syphilis, by congenital syphilis pregnancy outcome§ — Surveillance for Emerging Threats to Pregnant People and Infants Network, Arizona and Georgia, 2018–2021
Abbreviation: CSTE = Council of State and Territorial Epidemiologists.
*Any substance use includes any use of tobacco (e.g., cigars, cigarettes, smokeless tobacco, or e-cigarettes), alcohol, cannabis, illicit use of opioids (e.g., prescription opioids not taken as prescribed, fentanyl, or heroin), and other illicit, nonprescription substances (e.g., cocaine, methamphetamines, inhalants, or hallucinogens such as LSD or PCP).
†Numbers in categories are not mutually exclusive.
§Congenital syphilis pregnancy outcome includes pregnancy outcomes that meet CSTE surveillance case definition for syphilitic stillborn and live-born infant with probable or confirmed congenital syphilis.
¶Unadjusted.
**Denominator = 409.
††Denominator = 408.
§§Includes prescription opioids not taken as prescribed, fentanyl, and heroin.
¶¶Includes other illicit, nonprescription substances (e.g., cocaine, methamphetamines, inhalants, or hallucinogens such as LSD or PCP).
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What is already known about this topic?
Substance use prevalence has increased among women with syphilis; however, its association with congenital syphilis is less clear.
What is added by this report?
During 2018–2021, the prevalence of substance use among persons with syphilis during pregnancy in Arizona and Georgia was nearly twice as high among those with a congenital syphilis pregnancy outcome (48.1%) as among those without this outcome (24.6%). Approximately one half of persons who used substances during pregnancy and had a congenital syphilis pregnancy outcome had late or no prenatal care.
What are the implications for public health practice?
The need for syphilis screening and treatment should be addressed at every health care encounter during pregnancy, especially among persons using substances.
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