Congenital Syphilis at a Tertiary Care Center in Alabama: An In-depth Analysis of Cases and Management 2013-2023.

BACKGROUND: Congenital syphilis (CS) remains a preventable yet increasing public health concern in the United States. Previous studies have indicated that CS management itself is frequently not consistent with Centers for Disease Control and Prevention (CDC) recommendations. In Alabama, surveillance data indicate an increase in cases, indicating a need for better maternal surveillance and treatment, as well as an increasing need for provider education in CS management. This study aimed to examine how CS is diagnosed and managed at our institution, a tertiary care center in Alabama, and to assess concordance with current CDC recommendations. METHODS: We conducted a retrospective cohort study of infants diagnosed with CS at the University of Alabama at Birmingham (2013-2023). ICD-10 code-identified cases were reviewed for CDC risk-based maternal and infant criteria. Descriptive statistics were used. RESULTS: Thirty-eight infant CS cases were identified, with 12 classified as less likely, 26 as possible/probable, but none as CS unlikely. Additional workups, including lumbar punctures and radiographs, were obtained for half of the less-likely cases. Documented follow-up post-hospital discharge occurred in 58%. CONCLUSIONS: Significant variability in CS risk categorization and management was observed when comparing evaluation as dictated by categorization, often exceeding guideline recommendations. Diagnostic uncertainty, incomplete maternal data and inconsistent follow-up were noted to contribute to prolonged hospitalization and discrepancies in surveillance. Optimized diagnostic approaches, provider education about guidelines and larger cohort studies with longer-term follow-up are needed to inform clinical practice and public health interventions.