LDH launches congenital syphilis prevention pilot to increase screening opportunities during pregnancy

The Louisiana Department of Health (LDH) is launching a new congenital syphilis prevention pilot aimed at increasing opportunities to screen pregnant women for syphilis.

Syphilis is a sexually transmitted infection that can cause serious health problems. Pregnant women infected with syphilis can pass the infection to their baby during pregnancy, which is called congenital syphilis. Screening for syphilis in pregnant women and treating it promptly when it is diagnosed is a critical strategy in preventing syphilis from being passed to newborns.

The five-year average number of congenital syphilis cases in Louisiana nearly doubled between 2019 and 2023, with 93 average cases per year, compared to the previous five-year period, which averaged 50 cases per year. Among 115 cases in Louisiana in 2022, seven were linked to either syphilitic stillbirths or early infant death.

The most commonly missed care opportunity among mothers linked to 2022 congenital syphilis cases was the lack of timely syphilis retesting within the third trimester.

Pregnant women receiving care at participating pilot sites will be screened for syphilis at regular intervals outside of current syphilis screening guidelines unless they choose to opt out. This screening will be performed using a point-of-care rapid test that will provide same-day test results and same-day treatment if positive. This universal screening protocol will ensure more opportunities for identifying syphilis cases in pregnant women and initiating treatment as early as possible. The Office of Public Health's (OPH) STD/HIV/Hepatitis Program (SHHP) is leading the pilot.

Syphilis can cause very serious health problems if not treated, but it is simple to prevent and can be cured with the antibiotic penicillin. Babies born to women with untreated syphilis may be stillborn (a baby born dead) or die from the infection as a newborn. They can also have serious health problems or develop health problems later on.

In 2014, as Louisiana faced a similar congenital syphilis crisis, the Louisiana Legislature mandated that providers offer syphilis screening during the first prenatal visit and again during the third trimester per Louisiana Act 459. However, data indicates that even with the 2014 policy change, missed opportunities to screen for syphilis continue to exist.

About 80% of mothers linked to congenital syphilis cases received prenatal care but there were missed opportunities for screenings during their care, including a test at delivery if the first and third trimester screenings did not occur. About 49% of all mothers linked to congenital syphilis cases did not receive the third-trimester opt-out screening required under the 2014 law.

"Implementing this pilot puts Louisiana on course to offer screenings at every opportunity a pregnant woman sees her provider - not just for the two opt-out screenings," said Louisiana Surgeon General Dr. Ralph Abraham. "We've heard from providers that there is some confusion about when they should order syphilis screenings during prenatal care. The approach under this new pilot is to eliminate that confusion and ensure women are automatically screened during every prenatal visit. Early detection and treatment are crucial to preventing congenital syphilis, and this pilot is an important step to combat a persistent threat to public health."

The pilot program will be implemented at the LSU OB/GYN clinic at Woman's Hospital in Baton Rouge (Sept. 23), Ochsner LSU Health-Monroe Medical Center (Sept. 30) and Our Lady of Lourdes Midwifery Clinic in Lafayette (late October). LDH will assess the effectiveness of the pilot project in reducing congenital syphilis cases and determine whether the pilot is feasible for expansion to providers across Louisiana.

In addition to the new pilot program, here is a look at other initiatives currently underway in Louisiana to reduce congenital syphilis:

Comprehensive congenital syphilis case reviews

When congenital syphilis is identified, regional medical directors (RMDs) and disease intervention specialists (DIS) review congenital syphilis cases with the SHHP medical director and other program leaders to identify barriers and missed opportunities to prevent future cases.

Designated LDH representatives contact providers to alert them about congenital syphilis occurrences and missed prevention opportunities. These conversations with providers are an opportunity to provide additional education about the threat syphilis poses to mothers and babies, and alerts them to opportunities to prevent the spread of the disease in the future.

In August 2023, the Department began sending official letters to providers involved in congenital syphilis cases. More than 300 letters have been sent so far.

Perinatal Case Management Program

Trained public health nurses and licensed clinical social workers work closely with regional DIS to identify pregnant women who are diagnosed with syphilis or named as a partner of someone diagnosed with syphilis. This is an opportunity to help guide pregnant women and their partners to expedient syphilis testing and/or treatment as needed.

Case managers continue to work with these women throughout their pregnancy to ensure they are linked to prenatal care and receive appropriate follow-up testing and treatment to prevent congenital syphilis from occurring.
This program currently operates statewide and serves approximately 400 women annually.

SHPDirectRX Bicillin Delivery Program

OPH central pharmacy and regional DIS deliver Bicillin to private OB/GYN providers and community health centers to increase the timely treatment of syphilis among pregnant women to prevent congenital syphilis cases. These healthcare providers face barriers in maintaining medication on-site.
The SHPDirectRX Delivery Program provided more than 300 syphilis treatments across the state in 2022.

Syphilis Home Observed Treatment Program (SHOT)

Regional OPH DIS and nurses provide in-home Bicillin treatment for pregnant women diagnosed with syphilis during pregnancy to eliminate barriers to timely treatment. After a successful pilot in Lafayette, Alexandria and Shreveport, the SHOT program was expanded statewide this year.

Provider education

SHHP employs a statewide nurse educator who provides outreach and training to prenatal and other healthcare providers to improve timely diagnosis and treatment of syphilis to prevent congenital syphilis cases.

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