Exploring the Rising Rates of Congenital Syphilis in California and Louisiana
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum, which can be transmitted during vaginal, anal, or oral sex, and transplacentally to a fetus during pregnancy (i.e., congenital syphilis). If untreated or inadequately treated, congenital syphilis (CS) can lead to miscarriage, stillbirth, prematurity, low birth weight, or death shortly after birth. Babies born with congenital syphilis who survive are at increased risk for a range of adverse health outcomes. Although congenital syphilis can be prevented through timely identification and treatment of a pregnant person with syphilis, the prevalence and incidence of CS increased sharply between 2013 and 2019 in the United States (U.S.). In 2017, the U.S. Centers for Disease Control and Prevention (CDC) released a “call to action” to address the nation’s rising rates of syphilis and CS infection. At this time, California was the state with the highest number of CS cases (n=281) and Louisiana had the highest CS incidence rate (93.4 cases per 100,000 live births). In response to the CDC’s call, our team partnered with researchers from Tulane University School of Public Health and Tropical Medicine, Louisiana State University Health Sciences and California State University Bakersfield to launch a two-site study in 2018 to examine knowledge, attitudes and behaviors related to CS and its prevention in California and Louisiana. Through 2019, we conducted qualitative research with prenatal care providers and pregnant and postpartum participants in Kern County, California and East Baton Rouge Parish, Louisiana.

Research Aims

Aim 1:
Assess prenatal care provider knowledge, attitudes, and practices around congenital syphilis and its prevention

Aim 2:
Assess how prenatal care providers and high-risk pregnant participants learn about congenital syphilis and where they seek information

Aim 3:
Evaluate high-risk pregnant participants’ knowledge of STIs and syphilis; patient decision-making around whether to seek prenatal care (focused examination of barriers like substance use) and patient use of prevention behaviors during pregnancy

Aim 4:
Seek recommendations for improving outreach to this population

Aim 5:
Generate ideas for a culturally appropriate way to engage high-risk pregnant participants in the use of prenatal care services.

Funding Source

This research was funded by the March of Dimes and the Centers for Disease Control and Prevention (U380T000199-05-00).


Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California.

Congenital syphilis in East Baton Rouge parish, Louisiana: providers’ and women’s perspectives.

A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California.

Understanding perinatal patient’s health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana 

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Research Team

Jennifer A. Wagman, PhD, MHS

Co-Principal Investigator

Emily Harville, PhD

Co-Principal Investigator
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine

Pierre Buekens, MD, PhD, MPH

Departments of Epidemiology and Obstetrics and Gynecology Tulane University School of Public Health and Tropical Medicine

Eunhee Park, MPH, PhD

Student Co-Investigator

Gloria Giarratano, APRN, PhD, MSN

Louisiana State University-Health Sciences Center School of Nursing

Marlene Nelson, MSW

California State University, Bakersfield

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