Colorado agency issues health order as congenital syphilis cases increase 700%

Heather Willard
·5 min read

DENVER (KDVR) — Colorado Gov. Jared Polis is rallying his administration for an all-government response to save the lives of babies threatened by syphilis and congenital syphilis cases.

The Colorado Department of Public Health and Environment issued a public health order Thursday declaring the epidemic and expanding testing opportunities for pregnant individuals. The health order says that the infection is preventable through timely testing and treatment during pregnancy and now requires healthcare providers to offer syphilis testing:

  • During the first and third trimester of pregnancy

  • At delivery

  • When there is a fetal death after 20 weeks of gestation

  • At correctional facilities

  • When a patient who is pregnant presents to urgent care during the before-mentioned intervals.

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“Syphilis was once a rare disease,” Jill Hunsaker Ryan, executive director of the state health department, said in a release. “We are very concerned about this growing epidemic, both in the state and nationally. It is devastating for babies, but there is an effective treatment if caught in utero. The public health order that I am issuing will help us catch more of these cases prior to birth.”

Rates of congenital syphilis and syphilis on the rise

Congenital syphilis is caused by the transmission of a syphilis infection from a mother to her fetus. It can cause the baby’s death, in addition to a wide array of severe health conditions like bone deformities, severe anemia or brain and nerve problems, according to the Centers for Disease Control and Prevention.

The CDC reports that 40% of babies with untreated congenital syphilis may be stillborn or die from the infection.

Colorado reported that from 2018 to 2023, congenital syphilis cases increased more than seven times in the state, from seven cases in 2018 to 50 cases in 2023.

So far this year, the state has received 25 reports of congenital syphilis cases, including five stillbirths and two neonatal deaths.

“All expecting parents hope for the same thing — a healthy and happy baby. This statewide, coordinated response will help provide more consistent testing and care for those who are pregnant to help save lives and protect public health,” Polis said in his announcement.

Common symptoms include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue, according to the CDC.

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Polis called on CDPHE to facilitate coordination between the Behavioral Health Administration, Department of Local Affairs, Department of Health Care Policy and Financing, Department of Human Services, Department of Corrections, Department of Public Safety and Department of Regulatory Agencies to collaborate even more in the face of an epidemic.

This increase in testing will be covered for Coloradans with Medicaid through Health First Colorado, according to Polis, which the Department of Health Care Policy and Financing administers.

“An aggressive and coordinated all-state response is appropriate at this stage of the epidemic,” said Scott Bookman, senior director for Public Health Readiness and Response at CDPHE. “Testing and immediate treatment are available at little or no cost. Our goal now is to get those services to Coloradans who need them as quickly as possible.”

Colorado state agencies taking action

CDPHE was directed to assist health care and correctional facilities and laboratories through technical support and staffing for an after-hours line for urgent needs.

The agency was also directed to continue to meet with providers, public health partners and other community groups to talk with them about syphilis and congenital syphilis, strategies to reduce cases and available resources.

The Department of Corrections was instructed to ensure testing upon entry into the DOC for those who are pregnant in their care, as well as in the inmates’ third trimester and postpartum, through the Denver Reception and Diagnostic Center.

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The Department of Public Safety will be the communication link between CDPHE and sheriffs and local governments who operate jails and is also working with sheriffs to support their testing programs.

The Division of Insurance was instructed to ensure that, per the Affordable Care Act, testing for syphilis is covered without co-pays for most Coloradans with commercial insurance.

The Department of Human Services plans to work with health care providers to ensure understanding of the public health order, in addition to ensuring recommended testing is offered and Coloradans are educated about the importance of testing and treatment for syphilis.

National syphilis rates also skyrocket

The American College of Obstetricians and Gynecologists issued new guidance on Thursday saying the screening should be done at the first prenatal visit, during the third trimester and at birth. Though the screening isn’t required, health professionals generally follow the group’s recommendations.

“The cases of congenital syphilis are definitely climbing, and they’ve been climbing over the last 10 years. And it’s completely preventable … It’s unacceptable,” said Dr. Laura Riley, who chairs the Department of Obstetrics and Gynecology at Weill Cornell Medicine and helped with the guidance. “We need to be able to do better diagnostics and treatment.”

Infections during pregnancy are generally treated with at least two doses of penicillin.

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Earlier this year, the CDC said more than 3,700 babies were born with congenital syphilis in 2022, the most in more than 30 years. U.S. health officials called for stepping up prevention, including screening with a blood test.

In its advisory, the obstetrics and gynecology group said CDC statistics show nearly 9 in 10 congenital syphilis cases that year “could have been prevented with timely screening and treatment.”

The Associated Press contributed to this report.

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