Cases of neonatal syphilis, which can be fatal, have increased more than 10-fold over the past decade and by nearly 32% in a single year, according to a report from the Centers for Disease Control and Prevention (CDC). published Tuesday.
The CDC said cases have reached “disastrous levels” in the United States. More than 3,700 cases were reported to the agency in 2022, compared to 2,855 in 2021 and 335 cases in 2012.
Syphilis is a sexually transmitted infection caused by bacteria that can persist in the body for many years. If left untreated, symptoms may disappear temporarily, but the infection may become active again months or years later. Advanced syphilis, although rare, can be fatal due to damage to the heart, brain, or other organs.
Mothers can also pass the disease to their children during pregnancy. This form of infection, known as congenital syphilis, can potentially lead to stillbirth, miscarriage, death, or developmental disorders such as blindness or hearing loss.
In 2022, 51 cases of congenital syphilis resulted in infant deaths and 231 in stillbirths.
But almost 90% of These cases could have been prevented with timely testing and treatment during pregnancy, according to the CDC report. In 40% of cases, there was no evidence that the pregnant person had received prenatal care.
“It’s amazing how all of this could be avoided if we just allowed patients to get tested and receive treatment,” said Dr. Irene Stafford, a maternal-fetal medicine physician at UTHealth Houston, who was not involved in the report.
Communities of color bear the greatest burden: Babies born to Black, Hispanic, or American Indian/Alaska Native mothers in 2021 were up to eight times more likely to have congenital syphilis compared to babies born to white mothers, according to CDC data.
The agency recommends that all pregnant women be tested for syphilis via a blood test during their first prenatal care visit. But in an ideal scenario, they would be screened as soon as they see a health care provider, said Dr. Robert McDonald, lead author of the report and a physician in the CDC’s Division of STD Prevention.
The report calls for more testing and treatment in emergency departments, prisons and drug treatment centers – settings that house patients with otherwise limited access to health care and at high risk for syphilis . These screenings should still be covered by insurance, McDonald said.
“We recommend that syphilis testing really be increased outside of traditional prenatal care,” he said.
Challenges of detection
Syphilis is a centuries-old infection that has seen a resurgence in the United States. The CDC said Tuesday that the country is currently experiencing the highest number of cases of congenital syphilis in more than 30 years.
Most cases of syphilis in the United States involve gay, bisexual, and other men who have sex with men. But over the past decade, the infection has spread to more heterosexual men and women.
In 2021, more than 70% of the United States lived in counties with high rates of syphilis — more than 4.6 cases per 100,000 residents — among women of childbearing age, according to the CDC. The infection usually begins with a painless sore in the mouth, rectum, or genitals, then may progress to other sores or a rash that is usually not itchy.
Stafford said cases in pregnant women often go unnoticed because they may be asymptomatic or nondescript.
“Sometimes people get a rash and think it’s dermatitis or eczema,” she said. “They don’t necessarily have a ton of worrying symptoms that a person would associate with an STI, so they’re often overlooked.”
Many pregnant women don’t even know they are vulnerable to infection, said Dr. Natasha Bagdasarian, Michigan’s state medical director.
“Many young women of childbearing age are unaware that syphilis still exists, let alone that they might be at risk and that their unborn baby might be at risk,” she said.
Stafford said even some doctors lack awareness.
“When you ask the average doctor, the average obstetrician, they say, ‘Is syphilis a problem?’ “, she said.
Why aren’t more people getting tested?
There are several reasons why pregnant women do not see a regular doctor such as an obstetrician/gynecologist: they do not have a car or health insurance, they have a job or caregiving responsibilities, or they have to struggling to find a provider who speaks their language, Stafford said.
Many of these people end up going to emergency rooms for their health problems, said Dr. Kimberly Stanford, an assistant professor of medicine at the University of Chicago.
“We actually examined the pregnant woman who used our emergency department. Of those who arrived in the first trimester, more than half had no prenatal care plan. They didn’t have a date. They didn’t have OB. They didn’t know how they were going to get one,” said Stanford, who was not involved in the CDC research.
The Covid pandemic has made it even more difficult for people to access prenatal care, which may explain why congenital syphilis has increased so sharply in recent years, said Dr. Natasha Bagdasarian, chief medical director of the Michigan State, which was also not part of it. of the report.
Many clinics and doctors’ offices have reduced their hours or switched to virtual visits, leading to fewer STI exams, she said.
“Covid has made a lot of things worse,” Bagdasarian said. “Syphilis was one of those things that it exacerbated, in part because of less preventive care, routine health care and in-person visits.”
Emergency screening
Syphilis testing should be standard practice for people who are sexually active and live in areas with high infection rates, but few emergency departments test for it regularly.
To confirm a diagnosis, doctors usually draw blood and send it to a laboratory for analysis. Hospitals, however, may not want to perform screenings because they fear they won’t be reimbursed for the cost of blood tests or won’t have enough staff to track patient results, Stanford said.
Her emergency department at the University of Chicago has found ways to overcome these obstacles, she said. For more than four years, the organization has regularly carried out syphilis and HIV screening tests. The program detected high rates of undiagnosed syphilis during the first six months or so: 97 people were positive out of nearly 9,200 screened.
“A lot of facilities will feel like it’s going to be extra work. It’s going to make a visit longer, it’s going to disrupt the workflow,” Stanford said. “One of the things we found as we scaled this project to a very large scale is that most of these obstacles really weren’t a problem.”
McDonald, the CDC official, said syphilis screenings can easily be integrated with other programs that routinely test for HIV, such as syringe services programs — which provide people who inject drugs with supplies sterile to prevent infection.
Get people treated immediately
However, testing someone for syphilis does not necessarily mean they will be treated: of nearly 2,200 cases of congenital syphilis last year in which the child’s biological parent received timely testing, only 12% received adequate treatment, according to the CDC report.
According to doctors, one of the main reasons for this is that patients do not return for a follow-up appointment.
“Once people leave the emergency department, they often don’t answer their phones,” Stanford said. “They may be very difficult to reach again.”
Although blood tests are the most common way of diagnosis, hospitals have a second option, McDonald said: Rapid tests involving a finger prick can immediately determine whether a person has had syphilis in the past, although the results are less precise.
“For someone who you think may not be able to come back for treatment, that person should be screened with a rapid test and could then be treated on site,” McDonald said.
Once the diagnosis is made for pregnant women and their babies, only one treatment is recommended: an injectable version of penicillin called Bicillin. Mothers often need to return to receive up to three injections (one per week) and babies usually need one intravenous injection for 10 days.
The Food and Drug Administration is report a shortage of Bicillin at the moment, but McDonald said the CDC has not received any reports of people not being able to access it during pregnancy.
Stafford said the shortage, however, could prevent people from receiving immediate treatment.
“What I notice is that other clinics that are having trouble getting penicillin don’t know what to do,” she said. “They’re just trying to divert the patient to another location, and then it’s a missed opportunity.”
