Assessing diagnostic accuracy of congenital syphilis using penicillin administration data through the Pediatric Health Information System (PHIS) database.

Background: Given the most recent report of the nationwide rise of congenital syphilis (CS), with over a 773% increase from 2012 to 2021 per the Center for Disease Control and Prevention, we sought to utilize penicillin administration and ICD-10 billing data as proxies to assess the accuracy of diagnosis of congenital syphilis among major tertiary care pediatric hospitals.

Methods: This retrospective cohort study drawing data from 49 major tertiary children's hospitals in the United States sought to determine whether administration of penicillin in infants 30 days or younger, excluding other common infectious diseases treated with the medication, correlated with recently reported congenital syphilis epidemiologic data.

Results: 2290 infants met inclusion criteria and received penicillin therapy, excluding infants with the most common secondary infections treated with penicillin, with 1123 (49.3%) of those included not having a syphilis diagnosis made. Of the neonates with a coded diagnosis of CS, (1107/1162) 95.3% received more than 1 day of penicillin therapy, and those not coded for CS that received more than 1 day of penicillin therapy was 37.9% (428/1128).

Conclusions: Our findings found a significant number of infants who had penicillin administration and laboratory and procedural workup performed suggestive of congenital syphilis consideration, without a congenital syphilis diagnosis billed. This may reflect an underestimation of what is notably a growing nationwide pandemic. By addressing the screening and treatment needs of patients with CS, we can help to address some of the socioeconomic inequities in pediatric and maternal healthcare, and further accurately characterize the extent of this increasingly prevalent disease process.