Congenital syphilis is still rising. Better treatment in pregnancy urged : Shots

Disease intervention specialists, like Deneshun Graves with the Houston Health Department, work to reach pregnant women at high risk of syphilis to get them testing and treatment to protect their babies.

Michael Wyke/AP

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Michael Wyke/AP

Disease intervention specialists, like Deneshun Graves with the Houston Health Department, work to reach pregnant women at high risk of syphilis to get them testing and treatment to protect their babies.

Michael Wyke/AP

It’s the latest sign of the country’s losing battle against many common sexually transmitted infections: New data show the number of babies born with syphilis has increased tenfold over the last decade in the U.S.

A report released Tuesday by the Centers for Disease Control and Prevention documents the rise from 2012-2022 and concludes there were many missed opportunities for prevention. It finds more than 3,700 cases of congenital syphilis in 2022 alone, representing about a 30% increase from the year before.

While syphilis can be effectively treated during pregnancy, the consequences can be severe if it’s not. It can cause stillbirth, miscarriage, premature birth and infant death.

Babies that do survive can suffer from bone malformations, blindness, deafness, and developmental delays among other long term health problems. In 2022, 231 stillbirths and 51 infant deaths were reported.

The increase in cases indicates that syphilis is spreading unchecked in much of the country, and also evidence of a breakdown in the public health infrastructure around maternal care, according to doctors and advocates who work in the field.

The new report found that more than half of congenital syphilis cases last year were among people who had a positive test, yet never received adequate or timely treatment.

“The situation is very serious,” says Dr. Laura Bachmann, chief medical officer for the CDC’s Division of STD Prevention. “We need to do things differently.”

The report authors recommend public health agencies and physicians increase efforts to reach pregnant people with timely testing and treatment, including broader testing of sexually active girls and women and their partners in areas with high syphilis rates.

Complicating matters, an ongoing shortage of the antibiotic used to treat syphilis has become a “significant problem,” forcing some health care providers to spend hours searching for reserves of the medication, says David Harvey, director of the National Coalition of STD Directors.

“We have a perfect storm in the United States of funding cutbacks, not enough testing and treatments and a lack of awareness of this out-of-control syphilis epidemic,” he says, “And babies are paying the price.”

A long-running problem

The upsurge in infant syphilis cases is sobering, but not surprising to those who work in public health and STI prevention.

Rates of chlamydia and gonorrhea have ticked up steadily for years now and syphilis is now at its highest level since the mid 1960s. More than two-thirds of the U.S. population now live in a county that has a high prevalence of syphilis among reproductive-age women.

“Of all STIs, syphilis is the one that demonstrates just how poor our national response is to sexual health challenges,” says Dr. Edward Hook, a professor of medicine and epidemiology at the University Alabama, Birmingham.

“Syphilis is a disease for which we have good tests. We have good therapy and we have the opportunities to successfully treat it,” he says, “It’s absolutely preventable.”

The problem is especially acute in the South — more than half of the congenital syphilis cases in the U.S. were recorded in that region — followed by the West, which accounts for another third.

Black, Hispanic and American Indian/Alaskan Native mothers are eight times more likely to be affected than white mothers.

Congenital syphilis is essentially a bellwether of the unchecked spread among adults of syphilis and other STIs, says Dr. John Vanchiere, chief of the division of pediatric infectious diseases at LSU Health Shreveport.

“You see congenital syphilis when there is a lot of syphilis in communities,” he says, “And there’s not enough testing happening to get it under control.”

In a given week, Vanchiere says they usually evaluate two to three babies for possible congenital syphilis in his area of northwest Louisiana.

“The good news is most of those babies are doing fine, but we do see some that require 10 to 14 days of treatment, and we do see moms whose babies deliver prematurely,” he says.

As with other STIs, syphilis tends to disproportionately affect gay, bisexual and other men who have sex with men, according to the latest CDC data.

But some state health officials have noticed an increase among heterosexuals, especially women of childbearing age. In Michigan, the state started seeing this about five years ago, says Dr. Natasha Bagdasarian, that state’s chief medical executive.

This change “has been challenging to communicate,” she says. “A lot of folks in the heterosexual community were not aware that syphilis was still circulating.”

Gaps in maternal care leave newborns at risk

The CDC data reveal that gaps in maternal care underlie the crisis. Close to 40% of the cases last year were among mothers who were not in prenatal care.

This reflects what Bagdasarian has found in Michigan where they review each case of congenital syphilis to understand why the infection was not diagnosed and treated.

“They may not have an OB-GYN or a midwife or someone that they follow up with long term. They may be women who get their care intermittently in urgent cares or emergency departments,” she says. “I’m seeing a lot of missed opportunities for testing.”

The problem goes beyond just testing because many of the cases were traced back to inadequate treatment following a positive test.

The CDC’s Bachmann points out that treating syphilis once it’s more advanced requires multiple shots, each given a week apart, which makes it more complicated to manage, if someone isn’t closely tied to health care.

She says the CDC is recommending increased use of rapid syphilis tests in urgent cares and emergency departments, and that providers consider starting treatment immediately following a positive test if the person is likely to fall out of care.

A shortage of a crucial medication

The ongoing shortage of Bicillin L-A — a long-acting antibiotic to treat syphilis — has become another stressor on the system, since there is no other treatment for pregnant adults, says Vanchiere at LSU. However it was not a factor in the latest data because these cases occurred before that started.

The CDC has issued guidance to jurisdictions to prioritize those who are pregnant when the medication is in short supply, and Bachmann says they’re not aware of anyone who’s been unable to get treatment due to the shortage during pregnancy.

While the supply isn’t expected to be fully recovered until next year, the maker of the drug, Pfizer says it’s responded to the “unexpected and sudden increase in demand” by ramping up production, increasing its output by 30% this year and shaving down the time it takes to make the final product by more than half.

David Harvey, who represents health department STD directors, says the uptick in congenital syphilis is a symptom of broader complacency around STI prevention, including cumbersome bureaucracy and cutbacks in federal funding.

He points out hundreds of millions of dollars that were allocated for the public health workforce were siphoned away as part of the debt ceiling negotiations.

“We expect the numbers to get even worse next year,” he says. “We have yet to see the willpower exercised by our political leaders to do what it takes to turn this situation around.”