Syphilis Could Be Eliminated In The U.S. Instead, Rates Just Hit A 20-Year High.

Anna Almendrala
Updated

The number of pregnancies affected by the sexually transmitted infection syphilis is at a 20-year high in the U.S., according to a new report from the U.S. Centers for Disease Control and Prevention. That indicates a serious breakdown in prenatal care delivery to the most vulnerable women in the U.S.

The effects of congenital syphilis on fetus and infant health are catastrophic and have lifelong consequences for children who contract it in utero.

An estimated 40 percent of pregnancies affected by syphilis end either in stillbirth, which is a pregnancy loss after 20 weeks of gestation, or the death of the infant soon after birth. Babies who survive infection in the womb can suffer birth defects like blindness, deafness, deformed bones and enlarged internal organs. Congenital syphilis can also cause cognitive developmental disabilities.

The number of cases of congenital syphilis is minuscule compared to the approximately 4 million births that take place in the U.S. every year. But public health experts are alarmed at the rise of congenital syphilis because the disease is completely curable with antibiotics if caught early.

The most recent national congenital syphilis rate, which was 23.3 cases per 100,000 live births in 2017, is also the highest reported in 20 years and represents a significant backslide from just a few years ago. It’s a 153 percent increase relative to the 9.2 cases per 100,000 births in 2013, and rates have been steadily increasing since then.

In 2017, doctors reported 918 cases of congenital syphilis, which led to 64 stillbirths and 13 infant deaths. The majority of these cases ― 72 percent ― are concentrated in six states in the South and West: Louisiana, Nevada, California, Texas, Florida and Arizona.

Western and Southern states had the highest rates of congenital syphilis in the U.S. (Photo: Centers for Disease Control And Prevention: STD Surveillance 2017)
Western and Southern states had the highest rates of congenital syphilis in the U.S. (Photo: Centers for Disease Control And Prevention: STD Surveillance 2017)

While each state has its own set of historical, economic and medical factors influencing the rise in congenital syphilis cases, the states with the highest rates of congenital cases are also the states with the highest rates of syphilis in adults.

This multiyear rise is a sign of two things: a broken public health system and a lack of access to medical care over a long period of time, said Dr. Rebekah Gee, secretary of the Louisiana Department of Public Health. Louisiana has the highest rate of congenital syphilis in the nation.

“Every case should be seen as a never event and an unacceptable outcome of broken systems of care that need to be mended,” Gee said in reaction to the CDC’s new report.

“It’s really just a strong indicator that we’re not doing something right,” added Rebekah Horowitz, a senior analyst with the National Association of County and City Health Officials.

Why Congenital Syphilis Is Rising

Syphilis rates hit an all-time low in 2000, and public health experts at the time thought that the U.S. had a good shot at eliminating the infection. But since then, rates of syphilis, along with other sexually transmitted diseases, have begun creeping up again.

From 2013 to 2017, rates of syphilis among reproductive-aged women increased from 2.1 cases per 100,000 women to 5.1 cases.

Congenital syphilis cases result from the infection passing from mother to fetus in utero, so the number of pregnancies and babies affected by the disease began increasing as well.

Cases of congenital syphilis tend to mirror trends in primary and secondary syphilis rates among reproductive-age women. (Photo: Centers for Disease Control And Prevention: STD Surveillance 2017)
Cases of congenital syphilis tend to mirror trends in primary and secondary syphilis rates among reproductive-age women. (Photo: Centers for Disease Control And Prevention: STD Surveillance 2017)

Testing for syphilis in the first trimester is a standard part of prenatal care for women in the U.S., but some women may not have prenatal care during their pregnancies. Alternately, they may test negative for syphilis in the first trimester but then contract the disease later on in their pregnancies.

This gives the Treponema pallidum bacterium an opportunity to pass through the placenta to the fetus. During a vaginal birth, a baby may also come in contact with an open sore on the mother’s genitals, contracting syphilis after it is born.

The risk of fetal infection depends on the stage of a woman’s syphilis infection. Some research shows that if a woman has latent syphilis (the stage at which she experiences few or no symptoms), she has a greater chance of giving birth to a healthy baby than someone with primary or secondary syphilis, who has symptoms like sores or rashes.

If a woman is at a high risk for syphilis or lives in an area where syphilis rates are high, the CDC recommends another syphilis screening test in the third trimester, upon the birth of her child, or whenever a pregnant woman first starts seeing a doctor if she doesn’t start in the first trimester.

Doctors are also being encouraged to tell all reproductive-aged people who get treated for syphilis about the risks it poses to pregnancies, Horowitz said.

“If someone comes in and they test positive for syphilis, you want to get them treated, but you also want to have a conversation with them about whether or not they intend to get pregnant in the near future,” she explained.

How High-Risk States Are Responding

Some experts suggest that the growing popularity of dating apps and a diminishing fear of HIV and pregnancy have made unprotected sex more common, which contributes to the spread of sexually transmitted diseases.

There is some evidence that changing sexual practices may in part be fueling the rise in STIs.

But the states with the highest rates of congenital syphilis are looking beyond individual sexual behavior to focus on population-based solutions, albeit with less money than they need.

In some high-risk states like Louisiana and Texas, the CDC’s third-trimester screening recommendation has been codified into law.

Louisiana, which has had the highest rate of congenital syphilis in the U.S. since 2012, enacted a law in 2014 requiring all doctor to screen women for syphilis and HIV in both the first and third trimesters. The state also began reviewing every single case of congenital syphilis in 2016 to see how each one could have been prevented.

A recent report examined all 79 cases in the state from January 2016 to July 2017 and found that doctors could have prevented at least one-third of them if they had followed CDC guidelines on syphilis screening and treatment.

Texas, which has the fourth-highest rates of congenital syphilis, enacted a similar law in 2015 and has also launched congenital review boards in Houston and San Antonio, cities with high congenital syphilis numbers. The review is ongoing.

Dr. Heidi Bauer, chief of the STD Control Branch with the California Department of Public Health, said that the agency’s data shows that some Californian women are skipping prenatal care entirely and showing up to give birth ― or have a stillbirth ― with a syphilis infection.

“We’re failing in that regard,” she said.

Because of this, California, which has the third-highest rate of congenital syphilis and the highest number of cases in the nation, is trying to think beyond the traditional intervention model. Instead of focusing just on prenatal screenings, the state health department is also reaching out to prisons, community organizations, substance use programs and homelessness services to get vulnerable people screened for the infection before they become pregnant.

A survey of California mothers who had syphilis during pregnancy between 2007 to 2015 found that more than half of them only started prenatal care in the third trimester, if at all. It also found that 44 percent of women who were diagnosed with syphilis during pregnancy between 2013 to 2015 said they had used methamphetamine in the year before their diagnosis, while 13 percent said they had exchanged sex for money or drugs in the year before their diagnosis.

“What we’re seeing with congenital syphilis are the folks who are really falling through the cracks,” Bauer said. “We’re talking about a very small population of women, but a really important population just from the standpoint of really needing extra help and extra services.”

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Also on HuffPost

Gender Differences In Sexual Pleasure

About 85 percent of men studied reported their partner had an orgasm during their most recent sexual event, while only 64 percent of women reported having had an orgasm. The data represents a gap in how women experience sex and how men <em>perceive</em> women experience sex. Findings suggest that men are more likely to experience orgasm when sex includes intercourse, whereas women are more likely to experience orgasm when they engage in a variety of sex acts.

The Definition Of Sex Is Changing

Researchers found 41 combinations of sex acts that participants reported engaging in during their most recent sexual experience. This includes solo acts such as intercourse and combinations of multiple acts, such as oral sex and partner masturbation. While intercourse is still the most common, "what it means to have sex can vary greatly from one person to the next," said Dr. Debby Herbenick. She added that by no means are there only 41 possible combinations; certain behaviors--kissing, for example--were not included in the study. "Health care providers might be wise to ask more specifically about the types of behaviors that they’re interested in, in terms of helping their patients or assessing risk for certain things, rather than just asking if somebody, for example, is sexually active," said Herbenick. The researchers suggest the the variability could be a response to public health successes around HIV awareness and safe sex.

A Third Of Women Experience Pain During Sex

Nearly one-third of women reported experiencing pain during the most recent time they had sex, compared to only five percent of men. Researchers expect this is due to vaginal dryness, possibly caused by not spending enough time on foreplay and not being thoroughly aroused. "We need to pay better attention to women’s experiences of pain and discomfort during sex, including how sex can be modified through communication, foreplay, positioning or product use to improve comfort and pleasure," said Dr. Herbenick.

Older Americans Have Active Sex Lives

As aging Americans live and stay healthy longer, and with the surge of popular erectile dysfunction medications, today's aging population is remaining sexually active for longer than previous generations. Roughly 45 percent of men and women in their 50s reported being sexually active; about one-third of men and women in their 60s; and 20 to 30 percent of men and women into their 70s and 80s.

Overall Condom Use Is Up

Condom use has increased in the past two decades, becoming a normative behavior in the U.S. One in four participants reported using a condom during their most recent intercourse experience. The rate went up to over 30 percent for single people. Condoms were used twice as often with casual sex partners as with relationship partners, a trend consistent for both men and women across age groups. About 70 to 80 percent of adolescents reported using condom in the most recent time they had intercourse.

Condoms Don't Necessarily Decrease Pleasure

Adults evaluated sexual arousal, pleasure and orgasm during intercourse similarly regardless of whether or not a condom was used. The data is contrary to the popular assumption that condoms reduce the quality of a sexual experience. Researchers attribute the findings to the fact that today's condoms are better fitting, more comfortable, and often include specialized lubricants and textures.

Many Older Americans Have Unprotected Sex

Condom use generally declines with age, with a rapid decrease after age 50. About 25 percent of people in their 40s reported using condoms, down to 14 percent of those in their 50s. Older adults who find themselves single for the first time in decades--due to marriage separation or the death of a loved one--are less likely to use condoms. Moreover, without the worry of pregnancy, older Americans can falsely assume they're not at risk. However the study showed much of the older population is dating, and sometimes dating more than one person at a time.

When Teens Begin Having Sex

During the short period of time between age 14 and 17, substantial changes occur in teenagers' sexual lives. Fourteen percent of 14-year-old males reported having any kind of sexual interaction with a partner in the last three months, compared to nearly 40 percent of 17-year-olds. For females the figures are slightly different, but the proportions were the same: nine percent of 14-year-old females were sexually active and 36 percent of 17-year-olds. According to Dr. Dennis Fortenberry, adolescents should not be thought of as a single, unified group; sex education should be tailored to those that don't have any sexual experience as well as those who do.

Adolescent Sexual Health Is More Than STIs And Pregnancy

"We really need to pay more attention to how adolescents' overall sexual and relationship experiences affect their health, not only as they're adolescents but as they mature into adults," said Dr. Fortenberry. Sexual health should not be judged solely by STIs, HIV risk and pregnancy, he said, but also "how they carry their sexual experiences and sexual learning into the relationships, either that they have and that they’re maturing with, or in the relationships that they form -- so that they’re able to express their sexuality with their chosen partner in ways that feel healthy to them, and are respectful of their partner and their partner’s needs."

Young People Are Not As Irresponsible As Believed

Somewhere between 70 and 80 percent of adolescents reported using condoms in the last time they had intercourse. Sexually active teens had the highest rates of condom use, followed by young adults in their twenties. Dr. Logan Levkoff said that while adolescents do have an "innate sexuality," there is a false portrayal of teens as, once they've had sex, every relationship they have afterward will contain sex. "What we’re finding through this data is that that’s really not the case."

Public Health Campaigns: What Worked, What To Focus On

Researchers view increased condom use as a public health success, but say there is still a lot of work to do, specifically focused on making older Americans aware of the risks associated with unprotected sex. "If there’s a rate of 40 percent of people using condoms, in public health, we may see that as a success," said Dr. Michael Reece. "We also have to remember though, that means that 60 percent of people didn’t use a condom."

This article originally appeared on HuffPost.