Gaps in the Care of Maternal and Congenital Syphilis in Hawai‘i, 2022–2023

Cases of syphilis are increasing in the United States and disproportionately affecting disadvantaged populations. One such population is Native Hawaiians and other Pacific Islanders, historically underrepresented in national data. To review cases of maternal and congenital syphilis in Hawai'i to better understand the magnitude and causes of the problem. A retrospective chart review was performed of all deliveries at the main birthing hospital in Hawai'i for the years 2022 and 2023 by mothers who tested positive for rapid plasma reagin (RPR) during pregnancy. Demographic and clinical data were collected from mothers and their neonates and compared between those with syphilis (RPR-positive/treponema pallidum particle agglutination-positive) and those without syphilis (RPR-positive/treponema pallidum particle agglutination-negative). The rate of maternal and congenital syphilis (per 100,000 births) for 2022 and 2023 combined was 487 and 296, respectively. Of 79 maternal cases, 45 (57%) received adequate care, while the others had gaps in their care, including: no prenatal care (23%), nontimely testing (21%), inadequate treatment (35%), and reinfection (21%). Identifying as Native Hawaiian, having Medicaid insurance, a history of a sexually transmitted infection, substance use, or alternative housing were associated with maternal syphilis. Congenital syphilis resulted in longer, more costly hospitalizations, discharge to alternative care, and deficient follow-up of the newborn. These findings underscore the challenges of maternal and congenital syphilis in Hawai'i. The study identified disproportionately affected groups that require focused attention. Further study is required to identify patient- and system-level barriers to care and develop realistic, culturally appropriate interventions.