Department of Anthropology, University of Maryland, College Park, MD.
Department of Health, Thomas Jefferson Health District, Charlottesville, VA.
Sex Transm Dis. 2018 Jul;45(7):442-446. doi: 10.1097/OLQ.0000000000000787.
Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. Although CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and CS, with the highest number of CS cases in northwest Louisiana, where Shreveport is located.
We conducted qualitative interviews with community members (women and frontline providers) living in Caddo Parish to obtain their views about factors that negatively impact CS prevention.
Participants described impediments in the pathways for prevention of CS. Lack of sexual and reproductive health education, discontinuities and fragmentation in health care insurance coverage, a dearth of referral points for prenatal care, and difficulty finding prenatal care providers who accept Medicaid can delay timely and adequate care for pregnant women. Participants reported that low reimbursement for necessary injections and difficulty obtaining required medication challenged efforts to screen and treat pregnant women according to guidelines.
Although CS is easily prevented, health system and policy obstacles in pathways to CS prevention and care may need remediation at state and local levels.
先天性梅毒（CS）不成比例地影响着少数族裔和少数族裔妇女，尤其是在美国南部。尽管通过对孕妇进行筛查和治疗，预防 CS 相对容易且费用低廉，但 CS 病例仍持续上升，且集中在少数几个美国县和州。2010 年，路易斯安那州的原发性、继发性和 CS 的发病率在全国最高，而位于路易斯安那州西北部的什里夫波特市的 CS 病例最多。
我们对居住在卡多县的社区成员（妇女和一线服务提供者）进行了定性访谈，以了解他们对影响 CS 预防的负面因素的看法。
参与者描述了 CS 预防途径中的障碍。性健康和生殖健康教育的缺乏、医疗保险覆盖的连续性和碎片化、产前护理转介点的缺乏以及难以找到接受医疗补助的产前护理提供者，都可能导致孕妇无法及时获得充分的护理。参与者报告称，必要注射的低报销率和难以获得所需药物，给按照指南筛查和治疗孕妇的工作带来了挑战。
尽管 CS 很容易预防，但 CS 预防和护理途径中的卫生系统和政策障碍可能需要在州和地方一级进行补救。
