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Clinical Obstetrics

Poster Session 3

(652) Opportunities to reduce inadequate treatment of syphilis in pregnancy associated with substance use disorder

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Substance use disorder (SUD) has been identified as a barrier to adequate maternal syphilis treatment. The objective of this study was to evaluate missed opportunities in adequate treatment for syphilis in an urban, safety-net hospital system with a consistent practice of screening and referral for clinical staging and treatment.

Study Design: We identified pregnant individuals with syphilis before or during pregnancy using reverse sequence screening followed by referral. Clinical staging for maternal syphilis, fetal evaluation, and treatment occurred in a specialized clinic for infectious diseases in pregnancy according to consistent protocol-driven practices across the healthcare system. SUD was identified by chart review and universal screening. We compared timing of penicillin treatment initiation among individuals with and without SUD. Groups included those treated prior to pregnancy, less than 30 or 30 or more days before delivery, or individuals lost to follow up before clinical staging. 

Results: From January 1, 2021 until December 31, 2022, 499 individuals were identified with syphilis prior to or during pregnancy, and 98(19.6%) had SUD. Primary substances used included 35 (35.7%) opioids, 19(19.4%) methamphetamines or stimulants, 19(19.4%) cocaine, 19(19.4%) cannabis, 5(5.1%) alcohol, and 1(1%) benzodiazepines. Compared to individuals without SUD, the frequency of treatment initiation less than 30 days before delivery, defined as inadequate maternal treatment, and the frequency of loss to follow up after referral was higher in individuals with SUD (Table).  Among 8 with SUD lost to follow up before clinical staging evaluation and treatment initiation, 3 (38%) used methamphetamines, 3 (38%) opioids, and 2 (25%) cocaine.

Conclusion: Among individuals with syphilis prior to or during pregnancy identified in an urban, safety-net healthcare system, 20% have substance use disorders. Despite uniform referral and treatment services for syphilis in pregnancy, facilitating expedited linkages to clinical care for this group may help reduce missed treatment opportunities.