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A Preview of A Late-Breaking Study at ACOG 2024

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Dr. Miele will be presenting “Syphilis Treatment Among People Who are Pregnant in Six U.S. States — SET-NET, 2018-2021” at ACOG 2024.

What is the central question that your study and/or presentation tries to answer?

We sought to describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis.

If applicable, what are the key findings from your study?

Missed opportunities persist for timely and appropriate treatment of syphilis during pregnancy. Fewer than two-thirds of people with syphilis in the study received adequate or timely treatment. These data reveal unique insights into how we can better protect pregnant people and their infants from syphilis. For example, in this study, people without timely prenatal care (at least one visit more than 30 days before the end of pregnancy) or no prenatal care were less likely to be adequately treated. However, nearly one-third of those with timely prenatal care were still inadequately or not treated. In addition, people with complicated lived experiences, such as reported substance use or being unhoused, were twice as likely to receive inadequate or no treatment.

How do these findings and/or conclusions potentially impact clinical practice?

These data demonstrate that in addition to improving access to prenatal care, approaches to improve syphilis care in settings outside of traditional prenatal care, including emergency rooms, substance use treatment facilities, jails/prisons, and shelters serving unhoused individuals, are needed. Any healthcare encounter during pregnancy is an opportunity to improve outcomes for pregnant people and babies by ensuring syphilis screening and prompt treatment. Congenital syphilis is preventable with timely testing and treatment before or early during pregnancy.

What else would you like attendees to know about your presentation?

Syphilis during pregnancy has dramatically increased in recent years. When left untreated, syphilis can lead to serious illness for pregnant people and their babies. Congenital syphilis has more than tripled in recent years. Over 10 times as many babies were born with syphilis in 2022 than in 2012.

More research is needed around syphilis testing and treatment, especially highly sensitive and specific rapid tests and oral treatment options during pregnancy. Effective interventions will require innovative, multidisciplinary partnerships.

Dr. Miele has no relevant conflicts of interest to report.

Illustration by Jennifer Bogartz

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