Introduction
The rates of syphilis among pregnant women and infants have increased in recent years,
particularly in the U.S. South. Although state policies require prenatal syphilis
testing, recent screening rates comparable across Southern states are not known. The
purpose of this study is to measure syphilis screening among Medicaid enrollees with
delivery in states in the U.S. South.
Methods
A total of 6 state–university research partnerships in the U.S. South developed a
distributed research network to analyze Medicaid claims data using a common analytic
approach for enrollees with delivery in fiscal years 2017–2018 and 2018–2019 (combined
N=504,943). In 2020–2021, each state calculated the percentage of enrollees with delivery
with a syphilis screen test during the first trimester, third trimester, and at any
point during pregnancy. Percentages for those with first-trimester enrollment were
compared with the percentages of those who enrolled in Medicaid later in pregnancy.
Results
Prenatal syphilis screening during pregnancy ranged from 56% to 91%. Screening was
higher among those enrolled in Medicaid during the first trimester than in those enrolled
later in pregnancy.
Conclusions
Despite state laws requiring syphilis screening during pregnancy, screening was much
lower than 100%, and states varied in syphilis screening rates among Medicaid enrollees.
Findings indicate that access to Medicaid in the first trimester is associated with
higher rates of syphilis screening and that efforts to improve access to screening
in practice settings are needed.
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REFERENCES
- Screening for syphilis infection in pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement.JAMA. 2018; 320: 911-917https://doi.org/10.1001/jama.2018.11785
Sexually transmitted disease surveillance 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2019/default.htm. Updated July 29, 2021. Accessed November 16, 2021.
- Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015.MMWR Recomm Rep. 2015; 64 ([published correction appears in MMWR Recomm Rep. 2015;64(33):924]) (Accessed November 16, 2021): 1-137https://doi.org/10.15585/mmwr.rr7004a1
- An epidemic of congenital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis screening after an outbreak in adults.Am J Public Health. 1999; 89: 557-560https://doi.org/10.2105/ajph.89.4.557
- Characteristics of mothers of live infants with congenital syphilis in Florida, 1987-1989.Am J Epidemiol. 1992; 136: 657-661https://doi.org/10.1093/oxfordjournals.aje.a116545
- Risk factors for congenital syphilis in infants of women with syphilis in South Carolina.Am J Public Health. 1998; 88: 597-602https://doi.org/10.2105/ajph.88.4.597
- Dotters-Katz S. Syphilis in pregnancy.Obstet Gynecol Surv. 2019; 74: 557-564https://doi.org/10.1097/OGX.0000000000000713
- Medicaid's role for women.Kaiser Family Foundation, San Francisco, CA2019 (Published March 28Accessed November 16, 2021)
- June 2020 Report to Congress on Medicaid and CHIP.Medicaid and CHIP Payment and Access Commission, Washington, DC2020 (Published JuneAccessed November 16, 2021)
- Medicaid coverage of sexually transmitted disease service visits.Am J Prev Med. 2019; 57: 51-56https://doi.org/10.1016/j.amepre.2019.02.019
- Socioeconomic disparities in sexually transmitted infections among young adults in the United States: examining the interaction between income and race/ethnicity.Sex Transm Dis. 2013; 40: 575-581https://doi.org/10.1097/OLQ.0b013e31829529cf
- Prenatal syphilis screening rates measured using Medicaid claims and electronic medical records.Sex Transm Dis. 2008; 35: 387-392https://doi.org/10.1097/OLQ.0b013e31815fa5bb
- Chireau M. Patterns in prenatal syphilis screening among Florida Medicaid enrollees.Sex Transm Dis. 2007; 34: 378-383https://doi.org/10.1097/01.olq.0000245908.23629.b8
- Racial and ethnic disparities in prenatal syphilis screening among women with Medicaid-covered deliveries in Florida.Matern Child Health J. 2008; 12: 378-393https://doi.org/10.1007/s10995-007-0247-7
- Explaining racial differences in prenatal care initiation and syphilis screening among Medicaid-covered pregnant women.J Health Care Poor Underserved. 2009; 20: 177-193https://doi.org/10.1353/hpu.0.0099
- Screening for human immunodeficiency virus and other sexually transmitted diseases among U.S. women with prenatal care.Obstet Gynecol. 2015; 125: 1211-1216https://doi.org/10.1097/AOG.0000000000000756
- Increasing syphilis diagnoses among females giving birth in U.S. hospitals, 2010-2014.Sex Transm Dis. 2019; 46: 147-152https://doi.org/10.1097/OLQ.0000000000000945
- Trends and characteristics of sexually transmitted infections during pregnancy: United States, 2016‒2018.Natl Vital Stat Rep. 2020; 69 (https://pubmed.ncbi.nlm.nih.gov/32510315/. Accessed November 16, 2021): 1-11
- Pathways to congenital syphilis prevention: a rapid qualitative assessment of barriers, and the public health response, in Caddo Parish.Louisiana. Sex Transm Dis. 2018; 45: 442-446https://doi.org/10.1097/OLQ.0000000000000787
- Innovative solutions for state Medicaid programs to leverage their data, build their analytic capacity, and create evidence-based policy.EGEMS (Wash DC). 2019; 7: 41https://doi.org/10.5334/egems.311
Natality information—live births. Centers for Disease Control and Prevention. https://wonder.cdc.gov/natality.html. Accessed November 24, 2021.
- Common misconceptions about data analysis and statistics.Pharmacol Res Perspect. 2015; 3: e00093https://doi.org/10.1002/prp2.93
- Who is in this study, anyway? Guidelines for a useful table 1.J Clin Epidemiol. 2019; 114: 125-132https://doi.org/10.1016/j.jclinepi.2019.06.011
Article Info
Publication History
Published online: January 05, 2022
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
