F2.01 - Oral Session: Test Me Baby One More Time: Public Health Approach to Preventing Congenital Syphilis Through Testing

Brief Abstract Summary: In response to a sharp rise in syphilis and congenital syphilis cases, Siouxland District Health Department (SDHD) launched a data-driven initiative in Woodbury County, Iowa through their community needs assessment process. By forming an STI Coalition, analyzing disaggregated data, and identifying high-risk groups, SDHD implemented targeted interventions including public education, provider outreach, and expanded testing via their Women Infant and Children’s Clinic (WIC). Key outcomes included universal prenatal and delivery STI screenings, streamlined lab protocols, and earlier STI testing for underserved pregnant clients.

Woodbury County saw the largest decrease in cases from 2023-2024 throughout the entire state. Syphilis cases (all stages) dropped from 158 cases in 2023 to 120 in 2024, and infectious syphilis and all stage syphilis are both down over 40% in Woodbury County in the first half of 2025 compared to the first half of 2024.

Detailed abstract description: Background
In response to a rise in syphilis rates, Siouxland District Health Department (SDHD) mobilized a data-driven response in Woodbury County, Iowa (pop. 105,941). In 2023, the county reported a syphilis rate of 150 per 100,000—over five times the state average—with cases jumping from 12 in 2020 to 158 in 2023, with 12 congenital syphilis cases from 2020 – 2024.

A Sexually Transmitted Infection (STI) Coalition was formed, through the Community Health Assessment & Improvement Plan process, that reviewed syphilis data and identified an alarming pattern: increasing cases among women rather than men who have sex with men, thus the re-emergence of congenital syphilis. These findings spurred the coalition to act swiftly and strategically as congenital syphilis can lead to health complications and death for a newborn.

Methods
SDHD led a multi-pronged initiative to raise public awareness and drive clinical change. Staff recorded educational podcasts and completed interviews to inform the public about the concerning growth of syphilis and congenital syphilis. SDHD sent an alert letter to all local OBGYN providers, encouraging STI testing, and hosted its first-ever Public Health Roundtable on syphilis, engaging over 30 practitioners in urgent discussion. Most recently, SDHD expanded testing access by offering STI screenings immediately following their Women Infant Child (WIC) visits for pregnant clients who are not yet receiving prenatal care. This initiative challenged SDHD to think creatively, securing approval from the Board of Health and Medical Director and revising existing policies—demonstrating that there is always room for innovative and tailored approaches to community planning.

Results
These efforts led to several significant system-level improvements. All three OBGYN clinics in the county now test for syphilis during both the first and third trimesters. The local hospital has adopted universal syphilis screening upon admission for delivery and partnered with SDHD to streamline test ordering protocols—reducing lab turnaround times from five days to just one. Additionally, SDHD’s WIC office now refers all pregnant clients for STI testing before they leave the health department if they haven’t yet received prenatal care. Local testing data shows SDHD is reaching the uninsured Hispanic population in their first trimester, who do not plan to seek prenatal care.

Syphilis cases (all stages) dropped from 158 cases in 2023 to 120 in 2024, and infectious syphilis and all stage syphilis are both down over 40% in Woodbury County in the first half of 2025 compared to the first half of 2024.

Conclusion
Through community collaboration, public education, clinical engagement, and targeted outreach through our WIC programs, SDHD initiated meaningful public health changes. This session will review these strategies in detail and share lessons learned to inform similar efforts in other communities facing rising syphilis and congenital syphilis rates