Congenital Syphilis Letter June 12, 2024

The North Carolina Department of Health and Human Services, Division of Public Health (NCDHHS/DPH) has identified at least one congenital syphilis case or related stillbirth in Mecklenburg County during the first quarter of 2024. In the last decade, North Carolina has experienced a 9-fold increase in reported syphilis infections among women and a 72-fold increase in reported congenital syphilis infections. To raise awareness, the Mecklenburg County Health Department and NCDHHS/DPH are sending a courtesy notice to all health care providers who provide clinical services to women of reproductive age in your jurisdiction.

Please consider using this case as an opportunity to review syphilis prevention, diagnosis, and treatment with your team. As a reminder, North Carolina requires all pregnant women to be screened for syphilis at least 3 times in pregnancy:

• At the first prenatal care visit, between 28-30 weeks gestation, and at delivery

Treatment should be initiated as soon as possible in accordance with the current CDC STI treatment guidelines- Syphilis During Pregnancy - STI Treatment Guidelines for all pregnant women with suspected or confirmed syphilis. To prevent congenital syphilis, it is critical that pregnant women complete a penicillin-based regimen appropriate for their stage of infection.

• Primary, Secondary, and Non-Primary Non-Secondary Early Syphilis (infection acquired in the prior
  12 months): Benzathine penicillin G 2.4 million units in a single intramuscular (IM) dose.
• Late or Unknown Duration Syphilis (infection acquired greater than 1 year ago or unknown duration):
  Benzathine penicillin G 2.4 million units IM given weekly, for 3 doses (7.2 million units total)

*Spacing between doses should be 7 days, but no more than 9 days, apart or the regimen will need to be restarted.

Please report all suspected and confirmed syphilis infections to Mecklenburg County Public Health within 24 hours by faxing the NC Communicable Disease Report Form to 704-336-6200 as mandated by North Carolina Administrative Code 10A NCAC 41A.0101. Providers resources for preventing congenital syphilis can be accessed online: Syphilis Resources for Providers | Division of Public Health. You may also direct questions to one of the Surveillance Coordinators by calling 980-314- 9225 or 704-614-6510.

Thank you for all you do to maintain and promote the health of North Carolinians.