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Table 1.  

Patient characteristics Congenital syphilis, no. (%) No congenital syphilis, no. (%) p value Crude odds ratio (95% CI) Adjusted odds ratio (95% CI)
Total 367 238,227      
Age group, d
   0–3 340 (92.6) 233,528 (98.0) <0.001 Referent Referent
   4–365 27 (7.4) 4,699 (2.0)   3.947 (2.60–5.73) 3.82 (2.52–5.55)
Sex†       Referent Referent
   F 179 (49.0) 116,615 (49.0) 0.981 1.003 (0.82–1.23) 1.01 (0.82–1.24)
   M 186 (51.0) 121,483 (51.0)   Referent Referent
   African American 261 (71.1) 103,102 (43.3) <0.001 2.83 (1.72–5.07) 2.26 (1.37–4.06)
   White 92 (25.1) 119,502 (50.2)   0.86 (0.51–1.58) 1.01 (0.60–1.86)
   Other 14 (3.8) 15,623 (6.5)   Referent Referent
   Nonurban 213 (58.0) 133,829 (56.2) 0.472 1.08 (0.88–1.33) 1.02 (0.83–1.26)
   Urban 154 (42.0) 104,398 (43.8)   Referent Referent
Primary expected payer
   Medicaid 340 (92.6) 152,221 (63.9) <0.001 7.11 (4.91–10.78) 5.24 (3.58–8.00)
   Private/other 27 (7.4) 86,006 (36.1)   Referent Referent

Table 1. Demographic characteristics of infants hospitalized with and without congenital syphilis diagnosis, Mississippi, USA, 2016–2022

Table 2.  

Infant characteristics Congenital syphilis, no. (%) No congenital syphilis, no. (%) p value Crude odds ratio (95% CI) Adjusted odds ratio (95% CI)*
Maternal substance use 340 233,529 <0.001    
   Y 73 (21.5) 5,597 (2.4)   11.14 (8.53–14.36) 9.39 (7.16–12.16)
   N 267 (78.5) 227,932 (97.6)   Referent Referent
   Very low birthweight 28 (8.5) 4,430 (1.9) <0.001 5.38 (3.55–7.81) 4.05 (2.67–5.90)
   Low birthweight 59 (17.9) 22,556 (9.7)   2.23 (1.66–2.94) 1.81 (1.35–2.40)
   Normal birthweight 242 (73.6) 205,901 (88.3)   Referent Referent
   Y 92 (27.1) 29,544 (12.7) <0.001 2.56 (2.01–3.24) 2.26 (1.77–2.86)
   N 248 (72.9) 203,985 (87.3)   Referent Referent
Newborn respiratory distress
   Y 72 (21.2) 21,204 (9.1) <0.001 2.69 (2.06–3.47) 2.54 (1.94–3.28)
   N 268 (78.8) 212,325 (90.9)   Referent Referent

Table 2. Delivery subcohort: clinical characteristic for infants with and without congenital syphilis, Mississippi, USA, 2016–2022

*Each of the models was adjusted for demographic characteristics, including race, sex, residence, and payer. We excluded newborns of undetermined/unknown sex from this analysis.
†Not all newborn records had recorded birthweight; therefore, we excluded newborns with unknown birthweight from this analysis (11 records for the congenital syphilis cohort and 642 records for the cohort without congenital syphilis). Very low birthweight, <1,500 g; low birthweight, 1,500-2,500 g; normal birthweight, >2,500 g.


Congenital Syphilis Spike in Mississippi, USA, 2016-2022

  • Authors: Manuela Staneva, MD, MPH; Charlotte Hobbs, MD; Thomas Dobbs, MD, MPH
  • CME / ABIM MOC Released: 9/20/2023
  • Valid for credit through: 9/20/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care clinicians, infectious disease specialists, obstetrician-gynecologists, pediatricians, and other healthcare professionals who treat and manage children at risk for congenital syphilis.

The goal of this activity is for members of the healthcare team to be better able to assess trends in the epidemiology and clinical outcomes of congenital syphilis.

Upon completion of this activity, participants will:

  • Distinguish characteristics of infants with congenital syphilis
  • Analyze changes in the incidence of congenital syphilis
  • Evaluate risk factors for congenital syphilis
  • Assess clinical outcomes of infants with congenital syphilis


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  • Manuela Staneva, MD, MPH

    Office of Communicable Diseases
    Mississippi State Department of Health
    Jackson, Mississippi

  • Charlotte Hobbs, MD

    Department of Pediatrics
    University of Mississippi Medical Center
    Jackson, Mississippi

  • Thomas Dobbs, MD, MPH

    John D. Bower School of Population Health
    University of Mississippi Medical Center
    Jackson, Mississippi


  • Tony Pearson-Clarke, MS

    Emerging Infectious Diseases

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: Boehringer Ingelheim; GlaxoSmithKline; Johnson & Johnson

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    Associate Director, Accreditation and Compliance, Medscape, LLC


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Congenital Syphilis Spike in Mississippi, USA, 2016-2022

Authors: Manuela Staneva, MD, MPH; Charlotte Hobbs, MD; Thomas Dobbs, MD, MPHFaculty and Disclosures

CME / ABIM MOC Released: 9/20/2023

Valid for credit through: 9/20/2024, 11:59 PM EST


Abstract and Introduction


In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.


Congenital syphilis (CS), caused by infection with the bacterium Treponema pallidum, is a severe disease with potential for immediate and long-term health complications. Infection in pregnant mothers can lead to serious neonatal conditions, such as deformities, hepatosplenomegaly, anemia, jaundice, and failure to thrive[1]. Even though syphilis can be asymptomatic in infants at birth, later sequalae, such as neurologic disorders, occur in ≈40% of untreated children[2]. In addition, syphilis has been associated with severe pregnancy outcomes, including spontaneous abortion, preterm delivery, stillbirth, and infant death[3].

According to Centers for Disease Control and Prevention surveillance data, the nationwide rate of CS increased by 30.5% in 1 year, from 59.7/100,000 live births in 2020 to 77.9/100,000 live births in 2021[4]. In some states, CS rates increased even more dramatically. In Mississippi, for example, CS incidence rose from 104.3/100,000 live births in 2020 to 182.0/100,000 live births in 2021, a 74.5% jump in a single year. For this study, we examined trends, demographics, risk factors, coexisting conditions, and outcomes among infants in Mississippi hospitalized with a CS diagnosis. We aimed to better understand this emerging public health crisis in a state that continues to experience deep social and health inequities.