Background: Rates of congenital syphilis (CS) in the United States have risen sharply in recent years. There has been sparse research centering the voices and experiences of birthing parents who have delivered infants with CS and prenatal providers in Chicago or the surrounding Midwestern United States to date. Additionally, there has been little research on the role of extrinsic factors, such as stigma and attitudes surrounding CS in an individual's community, in their entry into and retention in the CS prevention cascade. Methods: Semistructured interviews seeking to gather perspectives and factors related to the rise of CS were conducted with birthing parents who delivered infants with CS at a major academic medical institution (AMI) and the prenatal providers who served them. This was supplemented by retrospective data of birthing parent outcomes. Results: Barriers elicited during the interviews included insufficient penicillin uptake, limited transportation, poor communication between providers and patients, gaps in patient understanding or knowledge around CS contraction and treatment, missed appointments, appointment burden for patients, life stressors of patients, housing instability, childcare difficulties, and stigma related to the CS diagnosis. The quantitative data revealed differing proportions of CS outcomes and care between those with care within the AMI, those with care outside the AMI, and those who had no prenatal care. Conclusions: This study found numerous perspectives and factors that may explain the rise of CS along various stages of the syphilis care continuum through in-depth interviews of prenatal providers and birthing parents.

This retrospective cohort study drawing data from 48 major tertiary children's hospitals found heterogeneity in the diagnosis and management of congenital syphilis despite Centers for Disease Control and Prevention guideline recommendations. The noted overall rise in the number of congenital syphilis cases mirrors the nationwide increase.

This study seeks to understand the general adult population's knowledge, attitudes, and stigma towards meth-amphetamine use and people with a history of methamphetamine use utilizing a cross-sectional national survey. We analyzed data from a cross-sectional survey drawn from AmeriSpeak (R), a probability-based ongoing panel of over 35,000 households representative of the U.S. household population. We developed a 10-item social stigma scale, and estimated a multivariable generalized linear regression model for public stigma towards metham-phetamine use as our dependent variable and a series of covariates. Six adjusted independent variables were noted to be significantly associated with higher stigma towards methamphetamine use: older age, higher household income, married status, Republican party affiliation, no history of methamphetamine use, and higher racism score. Sex assigned at birth, race (with Black as reference category), education level, and history of arrest or incarceration showed no statistical significance in stigma scores. In a separate regression model limited to people with a history of methamphetamine use (n = 727), notably White respondents had lower stigma compared to Black respondents. Our large population-based survey identified several factors associated with higher stigma towards those who use methamphetamines, including higher racist attitudes which was associated with a higher stigma score and higher internalized stigma amongst Black respondents with a history of meth-amphetamine use. Given the scope of methamphetamine use in the U.S., addressing stigma, in particular in regard to race, may impact the nation's public health efforts to reduce methamphetamine-associated adverse outcomes.

Background/Objectives: As congenital syphilis incidence continues to increase yearly in the United States (US), recommendations from government and professional organizations aim to inform effective clinical practice, although it is unclear how closely these recommendations are followed. This study surveyed US pediatric specialists regarding their approach to congenital syphilis diagnosis and treatment to examine decision-making relative to practice guidelines and subspecialty. Methods: US pediatric physicians recruited from subspecialty directories were sent an online survey conducted in March–April 2024. The case-based survey elicited diagnostic and treatment decisions for different case definitions of congenital syphilis (proven or highly probable, possible, and less likely). Results: Among 442 respondents (56.8% women, 74.2% age 40–69, 57.7% 15+ years since training completion), 94.1% chose to evaluate and manage proven or highly probable congenital syphilis as recommended whereas only 45.8% did so for congenital syphilis considered less likely. Diagnostic and treatment decisions by infectious disease specialists and other subspecialists differed across case definitions. Conclusions: Physicians’ approaches to congenital syphilis workup and management, including the decision to treat, varied with case presentation where decision-making seemed to diverge from published recommendations and between subspecialists as infection became less likely by case definition.

There has been an unprecedented surge in cases of Congenital Syphilis (CS), the vertical transmission of syphilis from a pregnant individual to their fetus, with over a 10-fold increase over the last 10 years. Infants may present with a wide variety of clinical presentations, with almost every organ system at risk of injury. Further adding to the intricacy of the disease, the majority of infants will be asymptomatic at birth, but due to ongoing inflammation associated with the disease, there may be a myriad of delayed morbid effects that take years to manifest. Diagnosis and management is dependent on a combination of the presence or absence of overt symptoms of the infant, noninvasive serologic examinations of the infant and pregnant individual, certain radiographic images of the fetus in utero or infant postpartum, indirect blood and cerebrospinal fluid markers of the infant, and the timing and adequacy of treatment of the pregnant individual prior to the delivery. This review is meant to help navigate the complexities of the presentation, diagnostic pathways, and treatment decision making processes required for CS.