Congenital syphilis cases rising

Syphilis is rising to epidemic levels in the U.S., according to the Centers for Disease Control and Prevention. In 2022, there were more cases of the sexually transmitted disease than in the past three decades, including a rise in congenital syphilis in newborns.

Congenital syphilis in newborns occurs when mothers do not receive timely testing and treatment during pregnancy. A sexually transmitted infection, syphilis increases the chances of miscarriage and stillbirth. Infection can be passed on to the newborn during birth, increasing the chance of infant death and lifelong medical issues for a child.

According to CDC. data, more than 3,700 U.S. babies were born with syphilis last year — more than 10 times the number reported nationwide in 2012.

Sounding the alarm

The federal agency sounded the alarm this week and called on health care providers and agencies to step up their testing and to treat the disease earlier in pregnancy. Specifically, the CDC recommends state and local health authorities, social service providers and health providers:

Consider starting syphilis treatment right away following a positive rapid syphilis test during pregnancy if the patient faces greater obstacles to ongoing care (and still send for full confirmatory syphilis testing for optimal patient follow-up).
Use rapid syphilis testing and treatment during pregnancy in settings such as emergency departments, syringe service programs, prisons/jails, maternal and child health programs.
Address syphilis before pregnancy in counties with high syphilis rates, by offering to screen sexually active women and their partners for syphilis, as well as people with other risk factors for syphilis.
Work with local community health workers who can help to overcome additional barriers to syphilis testing and treatment during pregnancy.

“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” said C.D.C. Chief Medical Officer Debra Houry, M.D., M.P.H., in a November 7 announcement. “New actions are needed to prevent more family tragedies. We’re calling on healthcare providers, public health systems, and communities to take additional steps to connect mothers and babies with the care they need.”

Source: Public Health Seattle-King County

Washington State and King County numbers rise

Washington State is not immune from the crisis and has been working to address the increase for some time.

The 2023 S.T.I. Epidemiological Report from the Washington State Department of Health showed a marked increase in syphilis cases among people capable of becoming pregnant (from under 300 in 2017 to nearly 700 in 2021). Cases among babies climbed steeply from 6 in 2017 to 53 in 2021.

Public Health Seattle-King County has been collaborating with the state health department to reverse the upward trend.

Before 2019, King County hadn’t seen a case of congenital syphilis in many years. Three cases were reported that year. In 2021, 11 cases of congenital syphilis were reported in King County, and 12 in 2022. At least two syphilis-related baby deaths have been reported since 2019.

So far, in 2023, there have been 21 reported cases of congenital syphilis in newborns in King County. Matthew Golden MD, M.P.H., director of the county’s HIV/STI/HCV Program, stressed this week that cases are rising among all ages, including among teens.

Golden says his department meets regularly with representatives of large healthcare organizations to push for syphilis testing. He notes that in May 2022, the state and local public health agencies came together to promote what Golden believes is “the most far-reaching syphilis screenings in the U.S.”

Efforts reverse the upward trend in King County

Since then, the state and county health departments have been recommending that all sexually active women 45 who have not had a syphilis test since January 2021 test for the disease.

The guidelines promoted by the state and county “also identify populations in need of more frequent testing and recommend that all pregnant people be screened for syphilis at their first prenatal visit, at the time of third-trimester blood tests, and again at delivery (among those at elevated risk),” Golden said.

Public Health Seattle-King County is also conducting outreach testing among higher-risk populations, supporting staff to do testing in jails, and working to promote increased testing in emergency rooms.

“Syphilis can be fully cured with antibiotics,” Golden said. But, many with syphilis are asymptomatic and unaware that they have it.

“All pregnant people should be tested for syphilis at their first prenatal visit,” Golden stressed.

Just as King County health officials are doing, the federal health agency this week emphasized the importance of syphilis treatment beginning when pregnant women first test positive.

‘Something has to change’

“It is clear that something is not working here, that something has to change,” the C.D.C.’s Dr. Laura Bachmann said. “That’s why we’re calling for exceptional measures to address this heartbreaking epidemic.”

In a release, Jonathan Mermin, M.D., M.P.H., director of C.D.C.’s National Center for H.I.V., Viral Hepatitis, S.T.D., and T.B. Prevention, added: “The congenital syphilis epidemic is an unacceptable American crisis. All pregnant mothers—regardless of who they are or where they live—deserve access to care that protects them and their babies from preventable disease.

“Our nation should be proactive and think beyond the OB/GYN’s office and bridge prevention gaps. Every encounter a healthcare provider has with a patient during pregnancy is an opportunity to prevent congenital syphilis,” Mermin said.

To learn more about syphilis, it’s causes, symptoms, and stages go the Washington State Department of Health webpage dedicated to this issue.