Mortality associated with congenital syphilis in the United States, 1992-1998.
OBJECTIVE
To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality.


METHODS
We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992-1998.


RESULTS
From 1992-1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.4%. Untreated, inadequately treated, or undocumented treatment of syphilis during pregnancy accounted for 87.4% of reported cases. Among CS cases, there was an inverse relationship between the number of prenatal care visits (0, 1-4, 5-9, >/=10) and risk of fatal outcome. Among deaths, 52% of deliveries occurred by 30 weeks' gestation. Among live born infants with CS, death occurred more often in infants for whom no radiograph or cerebrospinal fluid evaluation was reported. Although both cases and deaths from CS declined from 1992-1998, there was no significant change in the case fatality ratio.


CONCLUSIONS
Mortality associated with CS continues to be an important public health problem that will resurge if adult syphilis rates increase. Because a large proportion of deaths occur at low gestational age, earlier diagnosis and treatment of maternal syphilis may substantially reduce the case fatality ratio.
Gust
Deborah A
DA
Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA. dgg6@cdc.gov
Levine
William C
WC
St  Louis
Michael E
ME
Braxton
Jim
J
Berman
Stuart M
SM
D000328:Adult; D001724:Birth Weight; D002487:Centers for Disease Control and Prevention, U.S. / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D011295:Prenatal Care; D015995:Prevalence; D013590:Syphilis, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D014481:United States / Q000453:epidemiology