Gaps In the Prevention of Maternal and Congenital Syphilis in Hawai‘i, 2022-2023
Anna Gan, Kelsey Shintaku, Rodolfo E BéguéAbstract
Background
There has been a significant rise in maternal syphilis (mSyphilis) and congenital syphilis (cSyphilis) cases in the US. While this issue impacts all communities, it has disproportionately affected Native Hawaiians (NH) and Other Pacific Islanders (OPI). Local and detailed information is necessary to effectively address the specific challenges faced by at-risk communities. In this single-center, retrospective study, we aimed to generate more granular data to identify gaps in the continuum of care in the prevention of cSyphilis in Hawai‘i, while also considering the social determinants of health affecting pregnant persons with syphilis.
Methods
A retrospective chart review of pregnant persons and their babies who delivered at Kapi’olani Medical Center for Women and Children (KMCWC) between January 2022 and December 2023 was performed. All patients with a positive rapid plasma reagin (RPR) test and their babies were included. Patients with a positive RPR, but negative Treponema pallidum particle agglutination (TP-PA) test (i.e., false-positive) were also enrolled for comparison.
Results
There were 79 cases of mSyphilis during the 2-year period from January 1, 2022 to December 31, 2023. We identified multiple gaps along the continuum of care including 1) no prenatal care (10.1%), 2) non-timely testing (8.9%), 3) inadequate treatment (15.2%), and 4) insufficient prevention of reinfection (8.9%) (Figure 1). Differences were noted in race composition with mSyphilis being more common among those self-identified as NH and less common among Asians. Individuals with mSyphilis were also more likely to live in alternative housing, have Medicaid Insurance, have a history of STIs, and have some form of substance use.
Conclusions
There are rising rates of mSyphilis and cSyphilis in some Hawai’i communities, which are linked to significant gaps in the continuum of care for prevention. These gaps are especially pronounced in underserved and underrepresented populations, including ethnic and socioeconomic minorities.