Background The absence of reported congenital syphilis cases in 16 states and territories across the United States of America in 2017 may be attributable to changes in prenatal care utilization within these states from 2013–2017. In order to determine whether there is a relationship between rates of reported congenital syphilis cases and prenatal care utilization in the United States, we assessed changes in 16 states and territories with a congenital syphilis rate of 0.0 per 100,000 per live births in 2017. We determined the association between rates of congenital syphilis and utilization from 2013 to 2017, and explored the association between utilization and changes to state, territorial, and local mandates on congenital syphilis.

Methods We retrieved vital statistic data on congenital syphilis infections; prenatal care; and patient demographics. We retrieved public reports of mandate changes from state, territorial, and local public health agencies. Vital statistic data were collected by the United States Centers for Disease Control and Prevention National Vital Statistic System from 2013 to 2017. Cases included births of Non-Hispanic and Hispanic postpartum patients, who received congenital syphilis testing after live births in 2013, 2014, 2015, 2016, and 2017. We analyzed the incidence rate ratio (IRR) of congenital syphilis cases and prenatal care utilization. We then analyzed mandates to assess whether any changes to congenital syphilis screening could explain suppression or elimination of syphilis.

Results Increases in prenatal care utilization led to a decrease in congenital syphilis rates, and associations were stronger within states with an overrepresentation of Non-Hispanic white patients.

Conclusion While mandates may explain suppression or elimination of congenital syphilis, additional research is needed to determine whether the reduction is predicted by patient demographics, rather than mandated screening.

Disclosure No significant relationships.