Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

BAOJIANG CHEN, PHD

Second Advisor

FOLEFAC ATEM, PHD

Abstract

Following an initial decrease in the incidence of congenital syphilis from 2008-2012, the rate of congenital syphilis rose by 38% across the United States between 2012-2014 (2). This trend followed a 22% rise in primary and secondary syphilis cases in women during the same period.(1) Vertical transmission of syphilis is a significant public health concern, contributing to stillbirth, infant mortality, and neurologic and skeletal morbidities in survivors. (2) The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for sexually transmitted infections (STI) including HIV, syphilis, and hepatitis B at the first prenatal visit regardless of prior testing. The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) also support similar recommendations. Yet, a CDC investigation into this epidemic revealed that 21% of women whose infants were diagnosed with congenital syphilis had no prenatal care, and of those who had at least one prenatal visit, 43% received no treatment for syphilis during pregnancy and 30% received inadequate treatment. (2, 3) Little is understood about factors associated with low STI screening during pregnancy in the US. In a 2014 study, Cha, et al. evaluated factors affecting the likelihood of STI screening in pregnant women in Guam. They found that the biggest barrier to STI testing was lack of prenatal care and insurance. Even women with access to prenatal care were not routinely screened for syphilis before 24 weeks’ gestation. Despite a 93.5% overall rate of screening for syphilis at any time during pregnancy, the authors found much lower screening 2 rates for other STIs, including 31% for HIV, 25.3% for chlamydia, and 25.7% for gonorrhea. (8) This suggests potential disparity in testing practices based on risk perception by providers or patients.

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