Master's Project Title:

Executive Summary: Combating Congenital Syphilis

MCH Student:

Miranda N. Collard

Date of Defense:

October 20, 2017


There has been a vast increase in the prevalence of syphilis in Kern County, California over the
last 5 years. There is little indication the spread of this disease is slowing. In the years 1995-
2011, congenital syphilis cases were rare with only six cases reported in 16 years. In 2012,
congenital syphilis cases began to rise along with female syphilis rates, and peaked in 2015,
with 28 cases of congenital syphilis (Hernandez, 2017).

The Kern County Public Health Services Department (KCPHSD) has been at the forefront of the
battle against syphilis in Kern County and has been launching campaigns in the county in an
effort to bring attention to this infection; particularly, congenital syphilis infections. Congenital
syphilis occurs when the syphilis infection is passed from an untreated woman to her fetus
during pregnancy. This summary examines the challenges one hospital in Kern County has                                                      encountered while delivering high quality obstetric and neonatal care to syphilis-infected patients.

KCPHSD’s mission statement is “To protect and safeguard the health and safety of the
community”. The department accomplishes this by supporting health through education,
awareness, prevention of disease, detecting and reducing health inequalities, and by designing
innovative solutions and programs to promote positive health outcomes (Public Health, 2015).
With just under 300 staff serving a population of over 880,000 residents, this can be a daunting
task. Collaborating with local hospitals is essential in ensuring program success when new
health challenges present themselves in Kern County.

Bakersfield Memorial Hospital (BMH) is one (1) of twelve (12) major hospitals in Kern County
and boasts an impressive list of services. This hospital is the home of the only burn center and
the only pediatric emergency department in the county. The hospital has a 31-bed Neonatal
Intensive Care Unit, an 8-bed Pediatric Intensive Care Unit, and an 8-bed Grossman Burn
Center unit. Their mission statement coincides with that of KCPHSD in that the hospital aims to
create partnerships in the community to improve quality of life and provide high-quality care to
our underserved population (Mission, Vision, Values, n.d.).

Field Experience
The original field experience objectives were tailored to meet the mission statements of both
organizations and were as follows: for the student to participate in establishing a maternal child
health program at BMH that could be expanded to the eleven (11) other hospitals in the county;
to collaborate with BMH to improve their partnership with KCPHSD (where the student is
employed as a Public Health Nurse); to improve health outcomes of high-risk infants and
children after discharge from BMH; and to link high-risk infants and children to services after
discharge from BMH.

During the student’s first visit to the hospital, the Labor and Delivery manager requested
information about caring for women and newborns infected with syphilis. BMH freely admitted
that they had no processes or protocols in place for syphilis positive patients. This issue was the
driving force behind the field experience that was subsequently launched. KCPHSD has
numerous policies and procedures for the evaluation and treatment of syphilis and follows the
Centers for Disease Control (CDC) STD Treatment Guidelines (See Attachments 4 and 5).
What BMH did not know was that KCPHSD had a Congenital Syphilis Prevention Program,
which includes intensive PHN case management of pregnant women diagnosed with syphilis
(See Attachment 2). KCPHSD’s program served as a basis for the field experience activities at

Although the field experience’s target population changed, the objectives remained the same.
The student performed numerous activities and collaborated with countless divisions of
KCPHSD and BMH to ensure best practices were being followed to reduce congenital syphilis in
the county.

Lessons Learned
The most surprising lesson learned was that well-known and highly respected health care
providers at BMH are not provided with the same education that is provided to all clinical staff at
KCPHSD. Throughout the experience, I too was able to sharpen my knowledge on this
infection, and have since become an effective liaison for both BMH and other KCPHSD staff
who have questions regarding case managing these complex patients. Another surprising
lesson what that BMH did not have any set policies or procedures for screening and treating
syphilis despite the fact that congenital syphilis has been on the rise for five (5) years. They are
now working to create policies and procedures to screen and treat all syphilis positive patients in
all departments, including the emergency department.

It is recommended that local public health awareness campaigns should continue ensuring
every Kern County resident is aware of their risk and the steps to take to prevent syphilis
infection. Additionally, to reduce the number of congenital syphilis cases, and the complications
associated with it, new policies and procedures in hospital systems related to evaluating,
testing, and treating syphilis in pregnant women, postpartum women, and newborns, should be
implemented as a part of all clinical staff orientation. KCPHSD could provide extensive trainings
to all key medical personnel throughout the county and offer community partners an opportunity
to establish a close relationship with experts in the field in an effort to improve their treatment
rates and subsequently reduce the complications associated with congenital syphilis.

Syphilis and congenital syphilis cases have started to slowly decline in Kern County because of
public health campaigns and the diligent, collaborative work of multidisciplinary teams across
the county. Since the resurgence of this infection came about so quickly, our county was
unprepared for and under-educated on how to manage it. Many physicians and health care
providers in practice have only read about syphilis, which presented many challenges in the
recognition and treatment of the infection. This field experience was an example of how
collaboration between public health practice and a private hospital can improve health outcomes
for vulnerable populations.

1. MediCal Quick Stats 2016 – California Department of … (n.d.). Retrieved October 5,
2017, from
2. Kern County, CA. (n.d.). Retrieved October 05, 2017, from ca/#top
3. State of the Air 2016 – American Lung Association. (n.d.). Retrieved October 5, 2017,
from of-the- air/sota-2016- full.pdf
4. Hernandez, K. (2017, September 6). STDs in Kern County . Lecture presented at 2016
Data Update in Kern County Public Health Services Department, Bakersfield.
5. Kern County Public Health Services Department. (2016, May 27). Health Alert [Press
release]. Retrieved from
_-Syphilis- Health-Alert_160518.pdf
6. Sexually Transmitted Diseases (STDs). (2017, September 26). Retrieved October 05,
2017, from syphilis.htm
7. Increase in Incidence of Congenital Syphilis — United States, 2012–2014. (2015,
November 13). Retrieved October 05, 2017, from
8. Mission, Vision, Values. (n.d.). Retrieved October 05, 2017, from hospital/about-
us/mission-vision- values
9. Public Health. (2015, October 12). Retrieved October 05, 2017, from