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STD Control Branch

Update on Congenital Syphilis in California

Julie Stoltey, MD MPHPublic Health Medical Officer

California Department of Public HealthSTD Control Branch

MCAH Action May 18, 2017Folsom, CA

STD Control Branch

Overview

• Summarize epidemiologic trends in STDs in California, including syphilis in women and congenital syphilis

• Describe syphilis stages and natural history• Review CDC guidelines for screening for syphilis in pregnant women

• Describe characteristics of congenital syphilis cases in California and prevention opportunities

STD Control Branch

Chlamydia, Gonorrhea, and Early SyphilisCalifornia Incidence Rates, 1995–2016

0

100

200

300

400

500

1995 2000 2005 2010 2016

Rate per 100,000

pop

ulation

28.4(N=11,173)

Rev. 4/18/2017

Syphilis

165.0(N=64,929)

504.7(N=198,607)Chlamydia

Gonorrhea

Provisional data 4.2017

STD Control Branch

0

100

200

300

400

500

1990 1995 2000 2005 2010 2015

Rate per 100,000

pop

ulation

Year

California

United States

CA=486.1

Chlamydia, California versus United StatesIncidence Rates, 1990–2015

Rev. 7/2016

2014=456.1(2015 n/a)

STD Control Branch

0

100

200

300

400

500

600

700

1990 1995 2000 2005 2010 2015

Rate per 100,000

pop

ulation

Year

Chlamydia, Incidence Rates by GenderCalifornia, 1990–2015

Total

Female

Male

Rev. 7/2016

STD Control Branch

01,0002,0003,0004,000 0 1,000 2,000 3,000 4,000

10‐14

15‐19

20‐24

25‐29

30‐34

35‐44

45+

Total

Chlamydia, Incidence Rates by Gender and Age Group (in years)California, 2015

Note: Age was “Not Specified” for 0.3% of female cases and 0.3% of male cases for the given year.Since this disease is often asymptomatic, reported cases may reflect chlamydial infectionsidentified through screening programs offered primarily to women.

Male Rate per 100,000 Female

Rev. 7/2016

STD Control Branch

0

300

600

900

1,200

1,500

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate per 100,000

pop

ulation

Year

NA/AN A/PI Black Latina White

Note: NA/AN = Native American/Alaskan Native, A/PI = Asian/Pacific Islander.Race/ethnicity “Not Specified” ranged from 33.1% to 40.3% of cases for females in any given year.

Chlamydia, Incidence Rates for Females by Race/Ethnicity California, 2006–2015

Rev. 7/2016

STD Control Branch

Chlamydia, Incidence Rates by County, California, 2015

Rev. 7/2016

STD Control Branch

Chlamydia among Females Ages 15‐24Incidence Rates by County, California, 2015

Rev. 7/2016

STD Control Branch

Ranking of County Chlamydia Rates among Females Ages 15‐24California, 2015

(with 95% Confidence Intervals*)

Rev. 7/2016

0

1,000

2,000

3,000

4,000Sacram

ento

Fresno

Solano

Kern

Men

docino

San Francisco

San Diego

Madera

Los A

ngeles

Santa Ba

rbara

San Be

rnardino

Humbo

ldt

Alam

eda

Butte

Stanislaus

San Joaquin

Lake

Kings

Contra Costa

Tulare

Del N

orte

Mon

terey

Sono

ma

Impe

rial

Shasta

San Luis Obispo

Plum

asRiverside

Inyo

Merced

Lassen

Glenn

Santa Clara

Santa Cruz

Yuba

Orange

Sutter

San Mateo

Napa

Tehama

Placer

Ventura

El Dorado

Amador

Yolo

Marin

Colusa

San Be

nito

Tuolum

neNevada

Trinity

Calaveras

Mon

oSierra

Siskiyou

Mariposa

Mod

oc

Rate per 100,000

pop

ulation State Rate = 2,869.3

* Confidence intervals were calculated using Poisson exact method; excludes counties with no cases or statistically unstable rates.Note: Rates are per 100,000 population.

Source: California Department of Public Health, STD Control Branch

STD Control Branch

0

200

400

600

1941 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2015

Rate per 100,000

pop

ulation

Year

California

United States CA=138.9

Gonorrhea, California versus United StatesIncidence Rates, 1941–2015

Rev. 7/2016

2014=110.7(2015 n/a)

STD Control Branch

0

50

100

150

200

250

1995 2000 2005 2010 2016

Rate per 100,000

pop

ulation

Year

Gonorrhea, Incidence Rates by Gender, California, 1995–2016

Female

Male

In 2016, MSM made of 65% of male interviewed cases; 34% of MSM were HIV+(MSM = Gay, bisexual, and other men who have sex with men)

Rev. 4/18/2017

STD Control Branch

0200400600 0 200 400 600

10‐14

15‐19

20‐24

25‐29

30‐34

35‐44

45+

Total

Gonorrhea, Incidence Rates by Gender and Age Group (in years)California, 2015


Note: Age was “Not Specified” for 0.4% of female cases and 0.3% of male cases for the given year.

Rev. 7/2016

STD Control Branch

Gonorrhea, Female Incidence Rates by Race/Ethnicity and Age Group (in years), California, 2015

WhiteHispanic

Black

0

250

500

750

1,000

1,250

1,500

1,750

10 ‐ 14 15 ‐ 19 20 ‐ 24 25 ‐ 29 30 ‐ 34 35 ‐ 44 45+

Rate per 100,000

pop

ulation

Age Group

11 timeswhite rate

7 timeswhite rate

Rev. 7/2016

STD Control Branch

Gonorrhea, Incidence Rates by County, California, 2015

Rev. 7/2016

STD Control Branch

Ranking of County Gonorrhea RatesCalifornia, 2015


Rev. 7/2016

0

200

400

600San Francisco

Lake

Shasta

Sacram

ento

Fresno

Humbo

ldt

Kern

Alam

eda

Los A

ngeles

San Joaquin

Solano

Tulare

Stanislaus

Butte

San Be

rnardino

San Be

nito

Del N

orte

Merced

Contra Costa

Kings

Tehama

San Diego

Yuba

Men

docino

Madera

Sutter

Sierra

Santa Clara

Riverside

Yolo

Sono

ma

Trinity

Glenn

Santa Ba

rbara

Orange

Ventura

San Mateo

Mon

terey

Santa Cruz

Marin

Tuolum

neSan Luis Obispo

Napa

Mariposa

Amador

Placer

Nevada

Colusa

El Dorado

Calaveras

Impe

rial

Lassen

Plum

asInyo

Siskiyou

Mon

o

Rate per 100,000

pop

ulation

State Rate = 138.9

* Confidence intervals were calculated using Poisson exact method; excludes counties with no cases or statistically unstable rates.Note: Rates are per 100,000 population.

Source: California Department of Public Health, STD Control Branch

STD Control Branch

0

50

100

150

200

1941 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2016

Rate per 100,000

pop

ulation

Year

CaliforniaUnited States CA=24.2

Early Syphilis*California versus United States Incidence Rates, 1941–2016

* Includes primary, secondary, and early latent syphilis.

2015=15.1(2016 n/a)

Rev. 1/2017Provisional data 4.2017

STD Control Branch

Early Syphilis, Number of Cases by Gender & Gender of Sex Partners, California, 1995–2016

0

2,500

5,000

7,500

10,000

1995 2000 2005 2010 2016

Num

ber o

f Cases

Year

ALL MALE

FEMALE

MSM

In 2016, MSM made of 72% of male cases; 55% of MSM were HIV+

Rev. 4/18/2017Provisional data 4.2017

STD Control Branch

0255075100125 0 25 50 75 100 125

10‐14

15‐19

20‐24

25‐29

30‐34

35‐44

45+

Total

Early Syphilis*Incidence Rates by Gender and Age Group (in years)

California, 2016


* Includes primary, secondary, and early latent syphilis.Rev. 1/2017


STD Control Branch

Early Syphilis*, Incidence Rates by County and GenderCalifornia, 2016

* Includes primary, secondary, and early latent syphilis.

FEMALES MALES


STD Control Branch

Ranking of County Early Syphilis* Rates among Females Ages 15‐44California, 2016


Rev. 1/2017

0

25

50

75

100

125

Rate per 100,000

pop

ulation

* Includes primary, secondary, and early latent syphilis.† Confidence intervals were calculated using Poisson exact method; excludes counties with no cases or statistically unstable rates.

Note: Rates are per 100,000 population.Source: California Department of Public Health, STD Control Branch

State Rate = 12.5


STD Control Branch

0

3

6

9

12

15

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate per 100,000

pop

ulation

Year

NA/AN A/PI Black Latina White

Note: NA/AN = Native American/Alaskan Native, A/PI = Asian/Pacific Islander.Race/ethnicity “Not Specified” ranged from 0% to 7.2% of cases for females in any given year.

Early Syphilis*Incidence Rates for Females by Race/Ethnicity

California, 2006–2015

* Includes primary, secondary, and early latent syphilis. Rev. 7/2016

STD Control Branch

Methamphetamine Use among Early Syphilis Cases by Sexual Orientation, California, 2007–2016

0

10

20

30

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Percen

t of Interview

ed Cases

Year

MSM only

MSW

Female

* Includes primary, secondary, and early latent syphilis.MSM=Men who have sex w/men, MSW=Men who have sex w/women, MSU=Men of unknown sexual orientation

Rev. 4/18/2017


STD Control Branch

0

25

50

75

100

125

1965 1970 1975 1980 1985 1990 1995 2000 2010 2016

Rate per 100,000

live births

Year

California

CA=35.6

Congenital SyphilisCalifornia versus United States Incidence Rates, 1963–2016

2020 Objective(9.6)

Note: The Modified Kaufman Criteria were used through 1989. The CDC Case Definition (MMWR 1989; 48: 828) was used effective January 1, 1990.California data prior to 1985 include all cases of congenital syphilis, regardless of age.

United States

2015=12.4(2016 n/a)


STD Control Branch

233 187 174 166 141 120 185 277 369 491

8567 61

47 4633

58

102

145

206

0

50

100

150

200

0

750

1,500

2,250

3,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Cases o

f Con

genital Syphilis (n

)

Cases o

f Syphilis amon

g Females (n

)

Year

Pregnant Not Pregnant Unknown Congenital Syphilis

Congenital Syphilis & Female Syphilis Cases by Pregnancy Status, California, 2007–2016


STD Control Branch

Congenital Syphilis Cases by County, California, 2016

Rev. 4/18/2017

San Bernardino


Los Angeles

Kern

Fresno

San JoaquinSacramento

San Diego

STD Control Branch

Primary and Secondary Syphilis — Rates of Reported Cases by State, United States and Outlying Areas, 2015 CA state ranking by rates: #3 overall

• #2 among males (23.0)• #2 among females (2.4)

Slide courtesy Dr. Kidd, CDC

STD Control Branch

Congenital Syphilis — Rates of Reported Cases by Region, United States, 2011–2015

0

5

10

15

20

2011 2012 2013 2014 2015

Year

West

South

Midwest

Northeast

Rate per 100,000 live births


STD Control Branch

Congenital Syphilis — Rates of Reported Cases by Region, United States, 2011–2015

0

5

10

15

20

25

30

2011 2012 2013 2014 2015

Year

West

South

Midwest

Northeast

Column1

Rate per 100,000 live births

CaliforniaCases/rate have quadrupled since 2012


STD Control BranchSlide courtesy Dr. Kidd, CDC

STD Control Branch

Syphilis Overview

• Causative organism: Treponema pallidum, a spirochete bacterium, that replicates in 30 hours

• Transmitted by intimate skin‐to‐skin contact• Causes systemic infection• Incubation period: 10‐90 days• Characterized by episodes of active disease

interrupted by periods of latent infection• Without treatment, remains chronic or resolves

STD Control Branch

Syphilis Natural History

30‐50%Exposure Primary 30% TertiaryLatentSecondary

25%

Neurosyphilis can occur at any stage

IncubationPeriod

3‐4 weeks

2‐6 weeks

After 3‐8 weeks lesions disappear spontaneously

2‐20 yearsPossible relapse

STD Control Branch

Syphilis Staging Flowchart

YES

Chancre Rash, etc.

NO

PRIMARY SECONDARYLATENT

ANY IN PAST YEAR?• Negative syphilis serology• Known contact to an early case• Good history of typical signs/symptoms • 4‐fold increase in titer• Only possible exposure was this year

NOYESEARLY LATENT(< 1 year)

LATE LATENT or UNKNOWN DURATION

SIGNS OR SYMPTOMS?

STD Control Branch

Treatment is Based on Duration of Infection

PRIMARY, SECONDARY, and EARLY LATENT (< 1 year)

LATE LATENT or UNKNOWN DURATION

Benzathine penicillin G 2.4 million units IM in a single dose

Benzathine Penicillin G 2.4 million units once per week for 3 weeks**

CDC 2015 STD Treatment Guidelines www.cdc.gov/std/treatment

**In pregnancy, must adhere to strict 7 days between doses

STD Control Branch

Brief Clinical Overview of Congenital Syphilis

Public Health Image Library, CDC

STD Control Branch

Early Congenital Syphilis (<age 2)Common Presentations

• Asymptomatic presentations are common– ~2/3 infants born with CS are asymptomatic at birth – if

untreated will develop symptoms• Bone abnormalities• Enlargement of liver +/‐ jaundice

– Hepatomegaly present in almost all infants with CS• Skin rash • Nasal discharge (“snuffles”)• Blood abnormalities• Neurologic abnormalities• Others

STD Control Branch

Syphilitic Rhinitis

Syphilitic Rash

Photos courtesy of Public Health Image Library, CDC and Dr. Norman Cole

STD Control Branch

Late Congenital Syphilis (>age 2)Common Presentations

• Hearing loss (puberty – adulthood).– Can develop suddenly

• Interstitial keratitis (5 years old – adulthood) – Inflammation of tissue of cornea, can lead to vision loss

• Bone or tooth abnormalities• Neurologic abnormalities• Gummas (granulomatous inflammatory response to spirochetes) in the skin or mucous membranes

• Others

STD Control Branch

Interstitial Keratitis

Photos courtesy of Public Health Image Library, CDC/Susan Lindsley

STD Control Branch

Hutchinson’s Teeth

Photos courtesy of Public Health Image Library, CDC/Susan Lindsley (left) and Robert Sumpter (rt)

Permanent incisor teeth are narrow and notched.

STD Control Branch

Perforation of hard palate

Photos courtesy of Public Health Image Library, CDC/Robert Sumpter

STD Control Branch

Saber ShinsClutton’s Joints

Photos courtesy of Public Health Image Library, CDC/J. Pledger

STD Control Branch

Syphilis in Pregnancy and Congenital Syphilis

STD Control Branch

Screening Recommendations – CDC

• All pregnant women should be screened for syphilis at the first prenatal visit

• Women who are at high risk for syphilis, live in areas of high syphilis morbidity, or are previously untested should be screened again both:– Early in the third trimester (approx 28 weeks GA)– At delivery

Penicillin treatment of pregnant women with syphilis is highly effective at preventing CS

STD Control Branch

Early Syphilis* among Females of Childbearing Age (15‐44)

Incidence Rates by County, California, 2016

California Counties with Third Trimester +/‐ Delivery Syphilis

Screening Recommendations for All Pregnant Women, 5/2017

* Includes primary, secondary, and early latent syphilis. Rev. 4/18/2017All 2016 data are provisional

STD Control Branch

CDC Screening Recommendations

• No infant should leave the hospital without the maternal serologic status having been determined at least once during pregnancy, and again at delivery if at risk.– If mother presents at delivery with no prenatal care, STAT RPR should be performed

– If baby has congenital syphilis and is asymptomatic, there is still an opportunity to treat the infant to prevent further morbidity

• Any woman who delivers a stillborn infant should be tested for syphilis

STD Control Branch

Treatment of Syphilis in Pregnancy

• The only treatment of syphilis in pregnancy is penicillin. There are no alternatives.

• Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.– Some experts recommend a 2nd dose of benzathinepenicillin G be given a week after the initial dose in early syphilis

• Pregnant women with penicillin allergy should be desensitized and treated with penicillin.

All patients with syphilis should be tested for HIV.

STD Control Branch

Early Prenatal Care, Screening, & Treatment is 98% Effective

58% 54%

97%

82% 80%

64%

98%

CS Incidence Stillbirth Perinatal Death Preterm Delivery

Screening (Hawkes 2011) Treatment (Blencowe 2011) Treatment (Alexander 1999)

Prevention Impact (%) by Outcome and Study

STD Control Branch

What are common pathways that a women delivers a baby with CS?

Woman acquires syphilis prior to pregnancy

Not diagnosed, not tested

Not adequately treated

SHE BECOMES PREGNANT

She acquires syphilis during pregnancy

Not diagnosed(late to prenatal care or no prenatal care, early screen negative and not repeated,

seroconverted afer birth)

Not treated (treatment not ordered, lost to follow up)

Late to treatment (treatment initiated <30 days prior to delivery)

Inadequate treatment (wrong drug or dose, lack or delay in 2nd or 3rd shots

for late latent syphilis)

AND/OR

AND/OR

OR

OR

AND

RARELY, among those diagnosed and treated: • Maternal treatment failure• Fetal demise • Permanent fetal damage prior to treatment

STD Control Branch

What do we know about the cases?California Project Area CS Cases 2007‐2015:

Infant Characteristics (n=391)

30%

32%

9%

10%

11%

7%

0 5 10 15 20 25 30 35

Preterm birth

Abnormal CSF

Reactive CSF VDRL

Long bone abnormalities

Signs of CS on exam

Stillbirth

Credits: Stoltey, Ng

STD Control Branch

Number of congenital syphilis cases, by maternal stage:

Majority of mothers had late syphilis

0102030405060708090100110120130

2007(n=36)

2008(n=26)

2009(n=28)

2010(n=20)

2011(n=18)

2012(n=23)

2013(n=50)

2014(n=70)

2015(n=120)

# of con

genital syphilis cases

Late syphilis Early syphilis Unknown stage

62%61%56% 63%50%61%42%61% 65%


STD Control Branch

Percent of congenital syphilis cases, by maternal age at delivery:

Majority of mothers were ages 20‐29

8%

58%

32%

1.5%0

10

20

30

40

50

60

70

< 20(n=32)

20‐29(n=227)

30‐39(n=123)

40‐44(n=6)

45‐49(n=1)

50+(n=1)

Unknown(n=1)

% of cases

Age

64%

61%56%

59%

STD Control Branch

Congenital SyphilisIncidence Rates per 100,000 (L) and Number of Cases (R) by Race/Ethnicity of

Mother, California, 2016

0

25

50

75

100

125

NA/AN API Black Latina White

Rev. 1/2017

0

25

50

75

100

NA/AN API Black Latina White

Incidence Rates Number of Cases

STD Control Branch

3rd trimester(n=63, 16.1%)

2nd trimester(n=57, 14.6%)

1st trimester(n=75, 19.2%)

No prenatal care

(n=137, 35.0%)

Unknown(n=14, 3.6%)

Received prenatal care, outside CA(n=3, 0.8%)

Received prenatal care, missing info(n=42, 10.7%)

When did mother initiate prenatal care?Over half of mothers initiated prenatal care only in

3rd trimester or not at all

Nationally, 74% initiate in 1st Trimester; only 6% in 3rd Trimester or not at all (CDC, 2011)

STD Control Branch

Syphilis screening at first prenatal care visit

Reasons for delay:oProvider erroro Lab off‐siteoPatient lost to follow‐up and labs never drawn

o Surveillance data incomplete

Tested within 7 days of first visit, n=119,

60%

Delayed or not tested, n=80, 40%

Among 199 mothers with documented first prenatal visit:


STD Control Branch

Treatment of mothers accessing prenatal care in 1st/2nd trimester with reactive test ≥ 30 days

prior to delivery (n=67)

31%

27%

16%

15%

10%

Treated Inappropriately

n=21

Adequately Treatedn=18

Not Treatedn=11

Started Treatment < 30 Days Before Deliveryn=10

Unknown Treatment

n=7

STD Control Branch

Maternal risk characteristics forinterviewed early syphilis cases (n=92)

70% (92 of 132) interviewed

22%

6.5%13%

44%

13% 13%

05101520253035404550

Methamphetamine use Exchange of sex for money,drugs

Jail, juvenile hall, prison

%

Risk in 12 months prior to diagnosis

2007‐12 (n=46) 2013‐15 (n=46)n=20

n=10

n=3

n=6 n=6 n=6

STD Control Branch

What will it take to eliminate CS?

• How can we use the epi data to drive program? • What additional data would be helpful?• How do we prioritize congenital syphilis prevention?• What partnerships should be leveraged?• How can we measure our effectiveness?• Are there policy solutions?

Previous Outbreaks in the U.S.

Crack cocaine, exchange for sex, NYC 1986‐88

Rural South, South Carolina 1991‐1993

Indian reservation, Arizona 2007‐2009

Chinese birth tourism, Los Angeles 2014

• Response requires customized strategies

STD Control Branch

Public Health Response: Points of Intervention to Prevent CS

Pre‐pregnancy

Pre‐pregnancy

During pregnancyDuring

pregnancy BirthBirth

• Screening/dx/tx• Timely partner

services• Accessible highly

effective contraception

• Linkage to prenatal care

• Screening/dx• Timely treatment

appropriate for stage• Timely partner

services• Case management• Prevent and detect

new infection

• Evaluation and treatment of baby

STD Control Branch

Partnerships: Shared Responsibility, Aligned Resources

FOCUSCongenital syphilis

MCAH, Birth defects prevention, MTCT of HIV prevention, Health insurance providers, PNC providers, EDs, Corrections, Drug Treatment

Women Family planning, pregnancy prevention, MCAHHealth insurance providers, Ob/gyns

Drug users CorrectionsCBOs and drug treatment

STD Control Branch

Congenital Syphilis Prevention Cascade, California Project Area 2007‐2014

10077 73 63

37

0

10

20

30

40

50

60

70

80

90

100

Infected with syphilis Received Prenatal Carein 1st or 2nd Trimester

Received SyphilisTesting >= 30 daysbefore delivery

Received timelyappropriate treatment

% Pregnant Women with Syphilis

Opportunity for Prevention of Disease and Complications

CS Cases PREVENTED

~4x More NON‐Pregnant Women with Syphilis

STD Control Branch

Congenital Syphilis

Prevention

Clinical

Policy

Surveillance/ Epidemiology

Disease Investigation

Health Promotion

STD Control Branch

Patient Education Materials

If you would like to customize and distributewithin your LHJ, contact Ashley Dockter at [email protected]

STD Control Branch

STD Control Branch

Update for Health Care Providers

STD Control Branch

STD Control Branch

STD Control Public Health ResponseConfirm pregnancy status on lab reports (females)

Prioritization by age, gender, pregnancy status

Ensure timely treatment of pregnant women

Contact tracing, partner testing and treatment

Field testing sexual/social contacts

Ensure adequate work up and treatment of neonates

STD Control Branch

Pre‐Pregnancy Prevention & Screening Strategies

Pregnancy prevention (LARC)

Pregnancy testing

Drug and mental health treatment

Venue‐based Screening

(Corrections*)

Syphilis screening & treatment in non‐pregnant

women

Syphilis screening & treatment of

MSW

STD Control Branch

Screening Adult Females in Correctional Settings: A Promising Approach

INTERVENTION: Qualitative (or STAT) RPR testing Search syphilis case registry database Treatment at the time of medical evaluation

OUTCOMES:• Treatment indicated for 190/760 (26%)• Increased syphilis treatment from 7% to 84% • Prevented 7 out of 8 potential congenital syphilis cases because

mother was treated before discharge from correctional facility• Cost: $8,200 to hook up STAT RPR equipment and registry and

$0.25 per STAT RPR screening test

Blank, S., et al. (1997). "New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women's correctional setting." Sex Transm Dis 24(4): 218‐226.

STD Control Branch

Media

STD Control Branch

Areas for potential synergistic efforts in prevention of congenital syphilis?

• Case management of pregnant women at high risk?• Outreach to pregnant women who are not accessing

prenatal care ?• Alignment with Fetal and Infant Mortality Review in select

counties?• Outreach to delivery hospitals in high‐morbidity regions?• Strengthen health care provider/public health partnership

in prevention of congenital syphilis?• Include information about congenital syphilis in provider

education activities?

STD Control Branch

Take‐Home Points:Congenital Syphilis in California

• Female syphilis and congenital syphilis cases are increasing in California.

• Most congenital syphilis cases canand should be prevented.

• What activities, opportunities, and partnerships are available in your local health jurisdiction to assist with congenital syphilis prevention?

• What information can the CDPH STD Control Branch provide that would enhance prevention efforts in your counties?

Clinical Guidelines and Consultation

www.cdc.gov/std/treatment/www.std.ca.gov

Clinician Warmline

510‐620‐3400

[email protected]

CDC STD Treatment Guidelines AppAvailable now, free

Thanks! [email protected]‐620‐3408

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