Missed Opportunities for Congenital Syphilis Prevention - Clark County, Nevada, 2017-2022.

In 2022, Nevada ranked eighth in the United States in incidence of congenital syphilis, a disease that can lead to stillbirth, miscarriage, or neonatal death. Appropriate and timely screening of pregnant females for syphilis and treatment, when indicated, are crucial for preventing congenital syphilis. Southern Nevada Health District (Clark County) disease surveillance data for 2017-2022 were reviewed to identify females of reproductive age (aged 15-44 years) with confirmed or probable syphilis who had a liveborn or stillborn infant with congenital syphilis and to assess their receipt of prenatal care, syphilis testing and, when indicated, syphilis treatment. Clark County emergency department (ED) visit data were reviewed for these females to explore whether ED visits might represent an opportunity to screen pregnant females for syphilis. Among 195 females identified, 43.1% (84) reported receiving prenatal care during pregnancy. Over one half (57.4%) of the females had at least one ED encounter ≥30 days before delivery and had not yet received testing for syphilis at the time of the encounter; syphilis testing was performed at 68.4% of these encounters. Lack of prenatal care was a considerable barrier to timely testing and treatment in Clark County, Nevada. Encounters in nontraditional care settings, including but not limited to EDs, could provide an opportunity for syphilis screening of pregnant females who do not access prenatal care. If linked to timely treatment, such encounters might help prevent congenital syphilis.