Among urban, parturient women in the US, the rate of positive serologic tests for syphilis is 2%-6%. The purpose of this study was to review the epidemiology of syphilis in our perinatal population and to determine if results of the routine laboratory evaluation affected infant treatment. Our publicly funded hospital delivered 12,922 infants in 1992 and 1993: 82% Hispanic, 13% black. Universal screening at delivery identified a positive MHA-TP in 345 women (2.2%). Medical records were reviewed for maternal history, demographic data, and infant's hospital course. Blacks had higher odds of positive serology vs Hispanics (odds ratio=11.3, 95% CI 8.8-14.3). Seropositive mothers with no treatment, undocumented treatment, partial treatment, or evidence of reinfection were considered untreated. Evaluations for congenital syphilis included a physical examination; complete blood count(CBC); platelet count; ALT, AST, and direct bilirubin; urinalysis; RPR and MHA-TP; cerebrospinal fluid (CSF) cell count, protein, and VDRL; and long bone radiographs. Table

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All thirteen infants with an abnormal physical exam, CSF, or radiographic findings consistent with congenital syphilis were born to untreated mothers(P<0.001). A single abnormal CBC, platelet count, ALT, AST, bilirubin, or urinalysis was observed in 16% of untreated mothers and 12% of treated mothers (P>0.2). Untreated maternal syphilis appears to be the best predictor of congenital syphilis. Results of non-specific tests such as the CBC, platelet count, ALT, AST, bilirubin, and urinalysis were not helpful in identifying infants who needed treatment. We speculate eliminating these tests would substantially improve medical resource utilization.