Congenital Syphilis Information for Providers

What Are We Doing? New York State's efforts to eliminate syphilis during pregnancy

The Department of Health's efforts to eliminate syphilis during pregnancy have been challenged by the increasing number of syphilis diagnoses across New York State, and strained resources. To reverse the increases and promote positive health outcomes for New Yorkers, the Department is employing data-driven approaches to policy and programming, intensifying education efforts, developing new initiatives, and supporting community engagement.

The New York State Department of Health promotes public health efforts that focus on normalizing discussions about sexual health and reducing shame associated with syphilis. It strives for the implementation of a combination of interventions to achieve this goal. This may include public policy changes, provider education, health promotion campaigns/messaging, community engagement efforts, and community-based programming which are critical to raising public awareness, addressing provider bias, and promoting equitable care.

New York State Requires Three Syphilis Screenings for Pregnant Persons

In New York State, pregnant persons should be screened at least three times during each pregnancy:

  1. At time of first examination
  2. During the third trimester, and
  3. Again, at delivery

Effective May 3, 2024, New York State requires a syphilis test on all pregnant persons during the third trimester of pregnancy under Public Health Law §2308, as amended by sections 4 and 5 of Part AA of Chapter 57 of the Laws of 2023. Before, syphilis testing was only required at the time of the first examination and again at delivery under 10 NYCRR section 69-2.2. With the addition of third trimester testing, the law now effectively requires at least three syphilis screenings during pregnancy. Additional screening may be warranted; more frequent screening during pregnancy is best made through a shared clinical decision-making process between the patient and provider. For additional details and guidance, refer to the following resources.

The New York State Department of Health fully supports this amendment as data show syphilis screening in the third trimester of pregnancy as a missed opportunity for testing, diagnosis, and treatment of a pregnant person to prevent syphilis during pregnancy.

1. Clinical Consultation is Available

The New York State Congenital Syphilis Prevention Program (CSPP), a collaborative effort between the Clinical Education Initiative and the New York State Department of Health AIDS Institute's Office of Sexual Health and Epidemiology and the Bureau of HIV/STI Partner Services, offers educational consultation to health care providers and public health representatives on persons diagnosed with syphilis in pregnancy with the inclusion of protected health information sharing that facilitates behind the scenes enhanced monitoring of treatment and follow up to optimize prevention of congenital syphilis.

The CEI Line 1.866.637.2342 is a toll-free number for clinicians in New York State to discuss a variety of topics including HIV, Sexual Health, and Drug User Health patient management with a specialist.

  • For questions on syphilis in newborns, press 6, then 1, to speak with a pediatric infectious disease specialist.
  • For questions on Sexually Transmitted Infections, including syphilis and syphilis in pregnancy, press 6, then 2, to speak with an adult infection disease specialist.

Additional information: Clinical Education Initiative or CEI, a New York State Department of Health AIDS Institute initiative, is designed to enhance the capacity of New York's diverse healthcare workforce to deliver clinical services to improve health outcomes. The Clinical Education Initiative's Sexual Health Center of Excellence provides clinical education, training, preceptorships, monthly Project ECHO™ sessions, Lunch and Learn webinars, printed quick-reference materials, and additional clinical tools at no cost for clinicians in NYS on several sexual health topics, including sexually transmitted infections. Visit www.CEITraining.org for more information, to request training, and find additional sexual health resources.

2. Every Congenital Syphilis Case is Treated as a Sentinel Event

Effective June of 2023, the New York State Department of Health Congenital Syphilis Response Team implemented a new process to immediately notify the birthing facility associated with a congenital syphilis birth with a recommendation to perform a root cause analysis collaboration with staff from the ambulatory and inpatient settings involved in the care of the affected person and/or family. This notification, referred to as a Sentinel Event Letter, requests that the root cause analysis findings be disseminated as appropriate and should guide the development, implementation, and evaluation of actions taken by the facility to reduce the risk of congenital syphilis in the future.

A request for medical records is sent along with the Congenital Syphilis Sentinel Event Letter. New York State and the Perinatal HIV Prevention Program collaborate to review the retrospective medical records of mothers and infants with reported congenital syphilis cases. The goal is to identify gaps in testing and treatment and promote compliance with New York State Public Health Law when caring for pregnant individuals and/or infants with syphilis.

3. A Congenital Syphilis Elimination Strategic Planning Group was Convened

In March 2023, the Congenital Syphilis Elimination Strategic Planning Group was established to develop a comprehensive, state-wide Congenital Syphilis Elimination Framework through a health equity lens. The planning group comprises collaborative partnerships between the New York State Department of Health and the New York City Department of Health and Mental Hygiene, with 39 members across New York State, including community-based organizations, clinical providers, persons impacted by congenital syphilis, and the general community. The planning group is responsible for developing strategies and recommendations via a Congenital Syphilis Elimination Action Plan to reach the goals of the congenital syphilis elimination framework.

  • The mission of the New York State Congenital Syphilis Elimination Strategic Planning Group is to implement a coordinated, comprehensive, and systematic approach to reducing and eliminating congenital syphilis.
  • The vision is to create a state where congenital syphilis has been eliminated, and persons of reproductive capacity and their sexual partners have equitable access to services free from stigma and discrimination.

Though the Congenital Syphilis Elimination Strategic Planning Group efforts are ongoing, efforts are guided by the Center for Disease and Prevention categorization of five critical Missed Prevention Opportunities for Prevention of Congenital Syphilis as the core of this group:

  1. Late identification of seroconversion during pregnancy
  2. No timely prenatal care and no timely syphilis testing
  3. Untimely syphilis testing despite proof of timely prenatal care
  4. Inadequate maternal treatment despite proof of timely syphilis diagnosis
  5. Clinical evidence of congenital syphilis despite maternal treatment completion

4. Health Promotion Efforts are an Ongoing Crucial Strategy:

In recognition of the crucial role that health promotion activities play in raising awareness, encouraging positive behaviors, and improving overall well-being, New York State Department of Health AIDS Institute's Office of Sexual Health and Epidemiology, Sexual Health Education Services team develops effective, innovative and science informed health promotion messaging, educational materials that seek to normalize and destigmatize sexual health while promoting health equity and an understanding of sexual health as well as the prevention/treatment of sexually transmitted infections. The team uses data and community input to inform initiatives. They also provide sexual health capacity building and support to internal and external partners such as local health departments. Educational materials are made available to the public and are featured on social media and the Department of Health website.

5. Acknowledgement that both Structural Racism and Stigma are Drivers of Congenital Syphilis

New York State is committed to ending preventable epidemics. Every case of congenital syphilis is entirely preventable. It requires tailored prevention messaging and timely identification and treatment. Removing barriers to screening and treatment and addressing stigma and health disparities are critical to reducing congenital syphilis rates and improving health outcomes.

  • Stigma: Stigma associated with sexually transmitted infections such as syphilis can lead to several negative consequences including delayed testing and treatment. It can also lead to feelings of shame, fear of disclosure, and isolation. These feelings can keep pregnant people accessing the care and services they need.
  • Health disparities: Despite prevention efforts, some groups of people are sexually transmitted infections more than other groups of people. Structural racism and prejudice contribute to disparities in maternal and neonatal outcomes, including congenial syphilis rates. Challenges such as barriers to care disproportionately affect marginalized populations. Socioeconomic factors, discrimination, or lack of insurance can impact access and lead to inequities. Furthermore, implicit bias on the part of healthcare providers may influence their decisions regarding screening and treatment.

As such, it is important for providers to be aware of the realities and challenges their patients might be experiencing and integrate a people centered care approach and have an open discussion of sexual identity, expression, experiences, preferences, and care planning and delivery with their patients.

Resources

Surveillance Data

Examine the most recent Sexually Transmitted Infection surveillance data and statistics. This document summarizes 2022 surveillance data for the three major notifiable bacterial sexually transmitted infections (STIs) in New York State (NYS): chlamydia, gonorrhea, and syphilis. It also provides regional profiles of Sexually Transmitted Infections.

Additional Resources

Contact the New York State Department of Health AIDS Institute Office of Sexual Health and Epidemiology at 518-474-3598 or stdc@health.ny.gov for information and assistance with disease reporting.