title: Gestational and congenital syphilis epidemic in the Colombian Pacific Coast.
abstract: BACKGROUND
  Congenital syphilis (CS) is a major global public health problem. Buenaventura, a socioeconomically deprived municipality in the Colombian Pacific Coast, accounts for 6.6% of all CS cases in Colombia. To begin to understand the main reasons for the high rates of the disease in Buenaventura, we conducted a retrospective electronic health record analysis of all infants admitted with CS during the first 7 months of 2011 to the Hospital Departamental de Buenaventura, the city's main birthing hospital.
  
  
  METHODS
  The diagnosis of gestational syphilis and CS was based on a predefined Colombian public health service algorithm. Clinical, laboratory, and sociodemographic parameters for all infants studied, including maternal access to prenatal care, syphilis serologic diagnosis, and adequacy of penicillin treatment, were abstracted and analyzed.
  
  
  RESULTS
  A total of 89 infants met the case definition for CS. Most mothers (80%) were affiliated with government-regulated or private health care insurance plans. While 64 (70%) of 92 attended at least 1 antenatal care visit and 59 of these 64 (84%) were screened for syphilis, only 5 (8%) of 59 received appropriate antibiotic therapy. Although most infants were asymptomatic at birth, prematurity (15/82) was common. Two infants died in the neonatal period, and 5 pregnancies ended in stillbirth.
  
  
  CONCLUSIONS
  Our findings confirm that Buenaventura has a very high incidence of CS and demonstrate that existing antenatal care gestational syphilis programs are flawed. Prevention strategies should emphasize enhanced early syphilis screening in pregnancy, preferably through the implementation of point-of-care testing in the community and same-day treatment with at least 1 dose of penicillin.
authors.affiliation: From the *Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; †Hospital Departamental de Buenaventura, Buenaventura, Colombia; ‡Secretaría de Salud Departamental del Valle, Cali, Colombia; and §Departments of Pediatrics and Immunology, University of Connecticut Health Center, Farmington, CT; ¶Division of Infectious Diseases, Connecticut Children's Medical Center, Hartford, CT.
authors.forename: Adriana R
authors.initials: AR
authors.lastname: Cruz
authors.forename: Maria Alejandra
authors.initials: MA
authors.lastname: Castrillón
authors.forename: Alba Yadira
authors.initials: AY
authors.lastname: Minotta
authors.forename: Luisa C
authors.initials: LC
authors.lastname: Rubiano
authors.forename: Martha C
authors.initials: MC
authors.lastname: Castaño
authors.forename: Juan C
authors.initials: JC
authors.lastname: Salazar
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003105:Colombia / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D010400:Penicillin G / Q000627:therapeutic use*; D019095:Point-of-Care Systems; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D011256:Pregnancy Outcome; D011634:Public Health; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D013590:Syphilis, Congenital / Q000188:drug therapy / Q000453:epidemiology*; D014210:Treponema pallidum / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D010400:Penicillin G