Outcomes of infants born to pregnant women with syphilis: a nationwide study in Korea

Background: Despite the expansion of antenatal syphilis screening programs, congenital syphilis (CS) remains a concern. Purpose: This study aimed to analyze the manifestation and progress of CS, including treatment and follow-up, based on a nationwide study. Methods: From the Korean National Health Insurance Service database, a total of 548 infants were examined for CS during their first year of life from 2013 to 2018. Neurosyphilis and complications were investigated using the International Classification of Diseases-10 codes. Results: The birth rate of infants from mothers with syphilis was 2.8 per 10,000 live births for 5 years, which is not indicative of a decreasing trend. Overall, 148 infants were proven or highly probable or possible of having CS with treatment for 10 days; 66 infants were possible or less likely of having CS with only 1-day treatment. Jaundice (56 %) was common, followed by hearing impairment (14 %), renal disease (8 %), and mental retardation (8 %). Fourteen cases of neurosyphilis occurred. Infants with complications, including mental retardation, eye involvement, hearing impairment, or renal disease, were significantly associated with neurosyphilis (OR 8.49, P < 0.0001). Of 250 patients who received treatment, 92.8 % were treated with one medication: benzathine penicillin was used in 73 % of patients. Only four patients were re-treated due to treatment failure. In addition to the treponemal test, fluorescent treponemal antibody-absorption was the most utilized tool for diagnosis and follow-up. Conclusions: Establishing standardized guidelines for the evaluation of CS, as well as the establishment of treatment regimens and follow up-plans for the disease, at a national level would help improve maternal and neonatal care and facilitate the eradication of CS in Korea.

Automated summary

Despite the expansion of antenatal syphilis screening programs, congenital syphilis (CS) remains a concern. This study analyzed the manifestation and progress of CS, including treatment and follow-up, based on a nationwide study. Complications such as jaundice, hearing impairment, renal disease, and mental retardation were common in infants with CS, with neurosyphilis significantly associated with complications.