Gaps in the Congenital Syphilis Prevention Cascade: Qualitative Findings from Kern County, California

Abstract
Background: Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California. Methods: Between May 2018 and January 2019, we conducted fve focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade. Results: Gaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identifed from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specifc congenital syphilis management strategies. Gaps in partner notifcation, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers. Conclusions: Congenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specifc gaps in prenatal screening and treatment are needed.

Keywords: Congenital syphilis, Syphilis screening, Sexually transmitted infection, Prenatal care, Social determinants of health, Qualitative methods

Download paper here

Recommended citation: Park, E., Yip, J., Harville, E. et al. Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California. BMC Infect Dis 22, 129 (2022).