The U.S. has a “dire” syphilis crisis that is impacting pregnancies. And babies are dying as a result, according to the Centers for Disease Control and Prevention.
Syphilis during pregnancy can lead to miscarriage, stillbirth, infant death and a lifetime of health complications for the baby, including blindness, hearing impairment and developmental delays. Those outcomes are preventable with appropriate screening and treatment.
Despite those dire outcomes, the number of cases of congenital or newborn syphilis in the United States has increased tenfold over the past decade, according to CDC officials, who sounded the alarm Tuesday about the increase.
In 2022, more than 3,761 babies were born with syphilis, compared to 334 cases in 2012. The 2022 case numbers are the highest in 30 years, officials told reporters during a media briefing Tuesday. Those 2022 cases included 231 stillbirths and 51 infant deaths.
A new CDC VitalSigns report says pregnancy-related syphilis cases “reflect health system failures.”
The report says that “lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis.” And it said those gaps were seen in most cases “across all races, ethnicities and U.S. Census Bureau regions.”
Dr. Laura Bachman, chief medical officer in CDC’s Division of STD Prevention, told reporters that close to 9 of 10 cases of newborn syphilis in 2022 could have been prevented if the mothers had received timely testing and treatment. According to CDC numbers, more than half did test positive for the sexually transmitted disease during their pregnancy, but didn’t get “adequate or timely treatment.” About 40% of cases involved mothers who it appears did not receive any prenatal care.
What is syphilis?
Syphilis is a bacterial infection that is typically spread through sexual contact. According to the Mayo Clinic, “the disease starts as a sore that’s often painless and typically appears on the genitals, rectum or mouth.” It spreads from one person to another through direct contact with the sores.
It can also be passed to a baby during pregnancy and childbirth and “sometimes through breastfeeding,” according to Mayo, which says early syphilis can be cured, “sometimes with a single shot of penicillin.”
The New York Times reported, “Syphilis was nearly eliminated in the United States about 20 years ago, but rose by 74 percent, to 177,000 cases, between 2017 and 2021. Other S.T.I.s are also on the rise: In 2021, there were 1.6 million cases of chlamydia and more than 700,000 cases of gonorrhea.”
Some of the challenges are supply chain issues. The preferred form of penicillin to use as treatment of syphilis during pregnancy is Benzathine penicillin G — and there’s a shortage right now. The Hill reported that Pfizer, the only company manufacturing the drug, predicts supply challenges won’t be resolved until at least the second quarter of 2024.
So CDC officials are recommending that particular antibiotic be used only to treat syphilis in pregnancy. Other cases can be treated with something else.
The Mayo Clinic article — and the health officials who spoke Tuesday — all recommend that pregnant women should be tested for syphilis at their first prenatal appointment and treated immediately if the blood test detects it.
Babies at risk
CDC’s experts said the increase in newborn syphilis cases has resulted from an increase in the number of women of childbearing age with the disease, compounded by social and economic factors that leave them without high-quality prenatal care, as well as by challenges in the prevention realm.
“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” CDC chief medical officer Dr. Debra Houry said. “New actions are needed to prevent more family tragedies. We are calling on health care providers, public health systems and communities to take additional steps to connect mothers and babies with the care they need.”
CDC said that babies born to Black, Hispanic or American Indian/Alaska Native mothers were at much higher risk of passing syphilis to newborns in 2021, compared to white mothers.
In 2021, more than 70% of the U.S. population lived in counties that had a high rate of syphilis among reproductive-age women, which CDC experts said was more than 4.6 cases per 100,000 women ages 15 to 44, which is prime childbearing age. CDC recommends that doctors do more to screen pregnant women for syphilis, particularly in areas with high levels of the disease, and that they consider starting treatment quickly if syphilis is detected even by rapid testing.
Dr. Robert McDonald, medical officer in CDC’s Division of STD Prevention, said patients should ideally be given a blood test as soon as they see a health care provider while pregnant. But he also recommended screening for syphilis outside of “traditional prenatal care,” including in substance abuse treatment facilities and prisons, among other places where people also receive care.
Other experts echo that. “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,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, in a written statement. “Our nation should be proactive and think beyond the OB/GYN’s office and bridge prevention gaps. Every encounter a health care provider has with a patient during pregnancy is an opportunity to prevent congenital syphilis.”
The report said a lack of testing or late testing accounted for 56% of cases in the West and half of cases in the Northeast, as well as 40% in the Midwest. In the South, 54.5% of cases of congenital syphilis were due to inadequate treatment.