Syphilis seropossitivity as a marker for cocaine use during pregnancy in non-opiate-using women in an urban population

Resurgent congenital syphilis has been linked to many factors, including substance abuse ind the H1V epidemic. 243 low-income urban women and their infants were recruited as part of a study of in olcro cocaine exposure. 87% were African American/African Caribbean. The average age was 262 years. 37% were primiparoos. None were known to be HIV-posiiivc. Mother-infant dyads were considered séropositive for syphilis if cither the mother's syphilis serology done at delivery or the infant's cord blood serology was positive. All positive non-trcponemal tests (RPR's) were confirmed with trcponcmal tests (MHA-TP's). 14 dyads (6%) were positive, with sérologie data available for both mother and infant in 12, and in mother or infant in 2. Of the 243 dyads, prenatal cocaine exposure by maternal report or biological assay was present in 130 (54%). None had urine or meconium assays positive for amphetamines, opiates, or phencyclidinc, or admitted to use (if these substances. 12 of 14 dyads (86%) with positive syphilis sérologies were also positive for cocaine exposure. The rale of syphilis scropositivity at delivery for women in this sample who used cocaine during pregnancy was thus 8%; the rate of syphilis seropositivily at delivery for those women of similar ethnicity and sociocconomic status who did not use cocaine in pregnancy was 2% (p = .02). Syphilis scropositivity at delivery in mother or infant was a strong marker for cocaine use during pregnancy in this population that did not use opiates or amphetamines. Urine toxicology screening specifically including cocaine should be considered for women who test positive for syphilis at any point during pregnancy.