HLTH 6362 Week 11 Congenital Syphilis Policy Paper Example

Policy Paper: Reducing Congenital Syphilis in South Dakota by Treating Infections Where They Are Found and Testing Beyond Prenatal Care, With a Statutory Third-Trimester Requirement as a Secondary Step, Each Option Weighed Against Stated Criteria

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Walden University

HLTH 6362: Sexual Health and Well-Being

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Month Day, Year

Policy Paper: Reducing Congenital Syphilis in South Dakota by Treating Infections Where They Are Found and Testing Beyond Prenatal Care, With a Statutory Third-Trimester Requirement as a Secondary Step, Each Option Weighed Against Stated Criteria

The Problem in Figures

South Dakota had the highest congenital syphilis rate of any state in 2023: 54 cases, a rate of 482.1 per 100,000 live births, against a national rate of 105.8. Among South Dakota women aged 15 to 44, syphilis of every stage reached 613.0 per 100,000, more than seven times the national rate of 83.3 (Centers for Disease Control and Prevention [CDC], 2024). Provisional state figures for 2024 show 40 congenital cases, including four syphilitic stillbirths and one death after birth, a 26% drop from 2023 but 150% above the five-year median (South Dakota Department of Health, 2025). The state attributes its 2024 congenital cases to insufficient, delayed or absent prenatal care.

Where Prevention Breaks Down

National analyses locate the failures. In 2022, late testing or inadequate treatment in pregnancy figured in 88% of all congenital cases (McDonald et al., 2023). In 2018, the most common missed opportunities were treatment that fell short even after a timely diagnosis, seen in 30.7% of cases, and prenatal care that began too late, in 28.2% (Kimball et al., 2020). Prevention therefore fails in two places: people are not tested in time, and people who are tested are not treated in time. Treatment must be a penicillin regimen matched to stage, and it must be under way 30 or more days before the birth (Workowski et al., 2021).

South Dakota's legal framework addresses only the first test. State law requires a syphilis test at the first prenatal examination and is silent on any later test (S.D. Codified Laws § 34-23-9); by contrast, the state health department recommends testing at the first visit, early in the third trimester and at birth, and extends screening to emergency, urgent and primary care for women aged 15 to 45 (South Dakota Department of Health, 2025).

Criteria

Options are compared on four criteria, set before the comparison:

1. Fit to the failure point: does the option address untimely testing, untimely treatment or both?

2. Reach: does it reach people outside routine prenatal care, whom the state identifies as the source of its 2024 cases?

3. Evidence: is there evaluated evidence that the option changes what it targets?

4. Feasibility: can it be implemented through existing state authority and providers?

Cost is not scored, because no source available here estimates costs for South Dakota.

Option A: Require Third-Trimester and Delivery Testing in Statute

Amend the statute to require a third-trimester test and a test at birth, matching the department's guidance.

Fit: addresses untimely testing of infections acquired after the first visit; does nothing for treatment.

Reach: limited to people in prenatal care or delivering in a facility.

Evidence: modest. In Michigan, after a 2018 law required first- and third-trimester testing, early third-trimester screening among Medicaid-covered deliveries rose from 37.1% in 2017 to 53.7% in 2023 (Diesel & Macomber, 2026). In New York City, under a 2019 mandate, early third-trimester screening reached only 29.7% of Medicaid-covered pregnancies from 2020 to 2022 (Tang et al., 2026). Mandates appear to raise later testing somewhat, but far from universally.

Feasibility: requires legislation; straightforward to draft.

Option B: Treat Where Infections Are Found

Fund and support clinics serving pregnant women, including prenatal, tribal, rural and urgent care sites, to stock benzathine penicillin G and, where appropriate, use rapid testing so that a positive result can lead to treatment at the same visit or within days, with health department partner services offered at the same time.

Fit: addresses untimely treatment directly, and rapid testing shortens the path from test to treatment.

Reach: extends treatment capacity to settings people already use.

Evidence: indirect. No evaluation available here measures the effect of on-site treatment on congenital cases. A Maricopa County, Arizona, facility survey found that only 11.9% of prenatal clinics gave benzathine penicillin G on site, citing cost and the perception that syphilis is rare (Gabir et al., 2025), which documents the gap this option would close but not the size of the benefit.

Feasibility: possible through grants and department programs without new law; depends on supply, training and clinic willingness.

Option C: Test Beyond Prenatal Care

Support emergency departments, urgent care centers, primary care clinics and correctional health services in following the department's guidance to test pregnant women and women of reproductive age, using electronic record prompts where available.

Fit: addresses untimely testing among people with little or no prenatal care.

Reach: the strongest of the three for the people the state links to its 2024 congenital cases.

Evidence: limited to the logic of the missed-opportunity analyses; no evaluation available here measures its effect on congenital cases.

Feasibility: builds on existing guidance; requires provider engagement and follow-up for positive results, which links it to Option B.

Comparison

Table 1

Options Against Criteria

Ratings summarize the sections above; no option has evaluated evidence on congenital outcomes.

Recommendation

The state should pursue Options B and C together as its primary response and Option A as a secondary step. B and C address both failure points and reach the people the state identifies as most affected; each depends on the other, because testing outside prenatal care only prevents congenital syphilis if a positive result leads to timely treatment. A statutory requirement would align law with guidance and may raise later testing modestly, as in Michigan, but evidence from two jurisdictions suggests it cannot carry the response alone.

Implementation Notes

The department could begin Option C under its existing guidance by asking hospital systems to add a syphilis testing prompt for pregnant patients and women of reproductive age seen in emergency departments, and by reporting back to providers on how many positive results reached treatment. Option B could start with a small number of high-volume sites, documenting the time from test to treatment before expanding. Option A could follow once those programs show where later testing is being missed, so that the statute codifies a practice the state has already learned how to support.

Limits of the Recommendation

The recommendation rests on national analyses and on evidence from other states. No source here measures the effect of any option on congenital cases in South Dakota, the 2024 state figures are provisional and costs are unknown. The department should track the share of positive tests in pregnancy treated at least 30 days before delivery as the measure that would show whether the response is working.

References

Attending physician to take blood sample from pregnant woman, S.D. Codified Laws § 34-23-9 (2025).

Centers for Disease Control and Prevention. (2024). Sexually transmitted infections surveillance, 2023. U.S. Department of Health and Human Services. https://stacks.cdc.gov/view/cdc/255132

Diesel, J. C., & Macomber, K. (2026). Modest improvement in universal prenatal syphilis screening five years after legislation enacted. Pregnancy, 2(1), Article e70219. https://doi.org/10.1002/pmf2.70219

Gabir, L., Bell, J., Praag, A., Rios, M., Devlin, S., Khurana, R., & Taylor, M. M. (2025). Think Syphilis: Evaluating testing and treatment services for pregnant women attending prenatal care in Maricopa County, Arizona. Sexually Transmitted Diseases, 52(12), 739-745. https://doi.org/10.1097/OLQ.0000000000002223

Kimball, A., Torrone, E., Miele, K., Bachmann, L., Thorpe, P., Weinstock, H., & Bowen, V. (2020). Missed opportunities for prevention of congenital syphilis, United States, 2018. Morbidity and Mortality Weekly Report, 69(22), 661-665. https://doi.org/10.15585/mmwr.mm6922a1

McDonald, R., O'Callaghan, K., Torrone, E., Barbee, L., Grey, J., Jackson, D., Woodworth, K., Olsen, E., Ludovic, J., Mayes, N., Chen, S., Wingard, R., Johnson Jones, M., Drame, F., Bachmann, L., Romaguera, R., & Mena, L. (2023). Vital signs: Missed opportunities for preventing congenital syphilis, United States, 2022. Morbidity and Mortality Weekly Report, 72(46), 1269-1274. https://doi.org/10.15585/mmwr.mm7246e1

South Dakota Department of Health. (2025). Syphilis in South Dakota: 2024 data and health care guidance.

Tang, J., Klingler, E. J., & Pathela, P. (2026). Early third-trimester syphilis screening adherence among Medicaid recipients in New York City, 2020-2022. Sexually Transmitted Diseases, 53(4), 225-230. https://doi.org/10.1097/OLQ.0000000000002277

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1-187. https://doi.org/10.15585/mmwr.rr7004a1