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Original research
Clinical characteristics and outcomes for paediatric patients admitted with congenital or acquired syphilis: a population-based cohort study
  1. Robert Brock1,
  2. Brett Edwards2,3,
  3. Shengjie Lu3,
  4. Angel Chu2,3,
  5. Ranjani Somayaji2,3,4,5
  1. 1 Department of Medicine, Heidelberg University, Heidelberg, Germany
  2. 2 Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  3. 3 Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
  5. 5 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Brett Edwards, Medicine, University of Calgary Cumming School of Medicine, Calgary, T2N 2T9, Canada; brett.edwards{at}


Objectives Paediatric congenital and acquired syphilis cases have been increasing since 2012 in the USA. Potential differences in associated hospitalisation trends and healthcare utilisation between the two syphilis entities have not yet been assessed. We sought to compare these entities and describe their clinical characteristics, distribution and impact in the USA.

Methods We conducted a population-based cohort study using the 2016 Kids’ Inpatient Database (KID) to identify and characterise syphilis-associated hospitalisations among paediatric patients (age 0–21 years) in the USA during the year of 2016. Length of stay and hospitalisation costs for patients with congenital and acquired syphilis were compared in multivariable models.

Results A total of 1226 hospitalisations with the diagnosis of syphilis were identified. Of these patients, 958 had congenital syphilis and 268 were acquired cases. The mean cost of care for congenital syphilis was $23 644 (SD=1727), while the treatment of a patient with acquired syphilis on average cost $10 749 (SD=1966). Mean length of stay was 8 days greater and mean total costs were $12 895 (US dollars) higher in the congenital syphilis cohort compared with the acquired syphilis cohort. In congenital syphilis, there were greater frequency of cases in the Southern and Western regions of the USA (p<0.001).

Conclusion Congenital syphilis was associated with greater healthcare-related expenditure than acquired syphilis in paediatric patients. In addition to improving patient outcomes, congenital syphilis prevention efforts may significantly reduce healthcare utilisation burden and cost.

  • syphilis
  • perinatal infection
  • infectious diseases

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  • Handling editor Deborah Williamson

  • Contributors RB assisted in project conception and drafted the manuscript. SL performed collection and statistical analysis of the data and drafted the methods. BE and AC assisted with project conception and edited and revised the manuscript. RS conceptualised the project, supervised data collection and analysis and edited and revised the manuscript. All authors agreed to the format and content of the current manuscript and agree to be accountable for the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data are available from Healthcare Cost and Utilization Project (HCUP; with appropriate data use agreements in place.