Resurgence of congenital syphilis in Trinidad.

Twenty-eight cases of congenital syphilis (CS) were diagnosed shortly after birth at the Mount Hope Women's Hospital, Trinidad, during the period January 1985 to December 1988. The average annual incidence of CS was 115 per 100,000 live births, and the absolute number of cases and annual incidence doubled in the latter 2 years of the study. Diagnostic criteria used were a positive VDRL test in the 23 liveborn infants (100 per cent), signs suggestive of CS and confirmatory post-mortem findings. All mothers attended antenatal clinic at least once and 18 (64 per cent) were 25 years or younger. Only 17 (68 per cent) of the 25 gravidae with a positive VDRL test received treatment. Of 11 untreated gravidae, two did not have a VDRL test done, one had a negative VDRL test, three delivered before test results became known, one went into labour before going for treatment, and four (two of whom were substance abusers) did not comply with instructions to obtain treatment. There were five stillbirths and five neonatal deaths. There was no perinatal mortality when treatment was given earlier than 5 weeks before delivery, but mortality increased steeply if treatment was delayed or not given at all during pregnancy. Factors which contributed to this rise in the incidence of CS were an increased incidence of syphilis in females and failure to treat infected pregnant women.