Congenital syphilis rates are soaring. Are we doing everything we can to prevent it from affecting our community?
Syphilis is a sexually transmitted bacterial infection that initially begins as a painless sore or chancre that presents on the mouth or genitals. The disease spreads by person to person contact through direct contact with the sore. Symptoms arise from 10 to 90 days after infection. Symptoms include fever, sore throat, swollen lymph nodes, hair loss and fatigue and they can often mimic many other diseases.
Syphilis can remain dormant in the body for years and can attack the brain, nerves, eyes, and other organs if untreated. Congenital syphilis is when a pregnant mother has syphilis and passes the infection on to the infant before birth. This can be catastrophic to the infant causing serious birth defects that can be devastating to the infant causing lifelong deficits or even still births.
What makes this more devastating is that this is all 100% preventable. Congenital syphilis is what health experts call a “never event,” as in something that should never happen because nearly every case is preventable.
Proper treatment at least 30 days before delivery decreases the risk for passing the infection to the baby by 98%. Treatment for syphilis is penicillin, which is one of the cheapest and oldest antibiotics. Mothers are falling through the cracks and not getting appropriate testing and treatment which is a complete failure of the health system.
A public health order needs to be issued to stop the surge of syphilis. The order will require a doctor to follow best practices outlined by the CDC which includes testing all pregnant women for syphilis three times: once in their first trimester of pregnancy, again in the third trimester and at delivery. The order will also require doctors to test pregnant women that are seen in the emergency department or in urgent care centers.
The U.S. Centers for Disease Control and Prevention’s Division of STD Prevention, Surveillance and Data Management reports that there has been about a 700% increase in the cases of congenital syphilis in the United States in the last decade with individual states having cases increase 3,300% in Mississippi, nearly 3000% in Oklahoma, 2,200% in Hawaii, over 1,800% in Washington and 1,600% in New Mexico. The most frustrating aspect is that just a decade ago, numbers were historically low due to diligent contact tracing programs.
There are several reasons for this reemergence. It is not uncommon that once a problem seems to “go away,” we longer put resources into it. CDC prevention funding for the prevention of sexually transmitted diseases has fallen more than 40% since 2003. Further adding to this problem, the Covid-19 pandemic created a shortage of qualified personnel to contact trace sexually transmitted infections when staffing was used to fight the coronavirus.
Also, Medicaid covers almost half of the births in the United States and rates of syphilis are six times greater in Medicaid beneficiaries compared to those covered by private insurance according to the CDC. Medicaid requires all pregnant women to be tested for syphilis in their first trimester, but state policies differ on repeat testing in the third trimester of pregnancy and at birth as well which is the gold standard to identify any cases that are contracted during pregnancy.
Syphilis is now most common in heterosexual women and their partners, and it seems to be more common in combination with substance abuse, especially methamphetamine abuse. This creates the problem that many women who are at risk of getting syphilis and passing it to their infants are already in vulnerable situations and can either be noncompliant in health care treatment or difficult for providers to reach.
A public health order needs to be issued to stop the surge of syphilis. Reach out to legislation in your area and demand a public health order to be issued to stop the surge of syphilis. To find your local legislator visit Connecticut General Assembly and contact them with your concerns of protecting our babies who do not have a voice.
In 2023 we should not be seeing syphilis at these rates when the disease can easily be treated with one shot of penicillin. We need to do better about caring for our pregnant mothers and their infants.
Kelly Duink is a Registered Nurse in the Neonatal Nurse Practitioner Program at the University of Connecticut.