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Cases of syphilis in newborns in the U.S. continue to rise, according to a recent report issued by the U.S. Centers for Disease Control and Prevention (CDC). The report emphasized a tenfold increase in cases in 10 years with a total of 3,761 cases of congenital syphilis in 2022 compared to about 335 cases in 2012.
“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” said CDC Chief Medical Officer DR. Debra Houry in a press release. “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.”
Syphilis is a sexually transmitted infection (STI) that is caused by bacteria and is spread through sexual contact. The infection evolves over four stages: primary, secondary, latent and tertiary, where symptoms and signs can progress.
Symptoms of syphilis in the primary stage include sores and can progress in the secondary stage to multiple sores and rashes. In the latent stage, there are no visible symptoms and without treatment, syphilis can exist in the body for years, according to the CDC.
“Syphilis is sometimes referred to as ‘the Great Pretender’ because symptoms can often appear like other diseases throughout the first stages,” according to a statement from San Bernardino County’s Department of Public Health. “However, syphilis should be included in testing for STDs, especially since symptoms can go away on their own but create other complications later.”
Congenital syphilis is a disease that is the result of a mother with syphilis passing the infection to the baby during pregnancy. Syphilis during pregnancy can result in miscarriages, stillbirth and infant death among other long-term medical issues. In 2022, 231 stillbirths and 51 infant deaths were reported to the CDC.
The CDC’s report found that nearly nine in 10 cases of newborn syphilis in 2022 could have been prevented “with timely testing and treatment during pregnancy.” More than half of cases were among people who tested positive, but never received adequate or timely treatment.
Roughly 40% of cases occurred in mothers who were not in prenatal care. In an emailed statement, the California Department of Public Health (CDPH) noted that “maternal risk factors associated with congenital syphilis in California include a lack of or late prenatal care, substance use, experiencing homelessness, a previous history of syphilis, and incarceration in the previous twelve months.”
One important risk factor for contracting syphilis is where people live. Some counties have higher rates of syphilis among reproductive-age women than others. Other factors that contribute to the rising cases of syphilis include social and economic factors that have created barriers to high quality prenatal care and ongoing declines in prevention, infrastructure and resources, explained Bethan Swift, CDC Epidemic Intelligence Service Fellow.
Swift works with the Riverside County Department of Public Health. In July, the department issued a public health advisory regarding “concerning syphilis trends” and the national shortage of Bicillin-LA, an antibiotic used to treat syphilis and other bacterial infections. Riverside County reported 42 cases of congenital syphilis in 2021, which represented a 55.6% increase in cases since 2019.
In San Bernardino County, congenital syphilis has primarily impacted Hispanic/Latino infants, Non-Hispanic white infants, and Non-Hispanic Black or African American infants, according to the County Department of Public Health.
According to the CDC, California had the 11th highest congenital syphilis rate of all states in 2021. Thirty-seven of California’s 61 local health jurisdictions reported at least one case of congenital syphilis in 2021. The CDPH reported congenital syphilis cases increased from 33 cases in 2012 to 528 cases in 2021.
In 2022, there were 615 congenital syphilis cases reported to CDPH. The highest congenital syphilis rates were among those who identify as American Indian/Alaska native (941.3 cases per 100,000 live births) and African American (383.6/100,000), compared to Hispanic populations (173/100,000) and white populations (133.42/100,000).
In an effort to address congenital syphilis cases, the CDPH’s Sexually Transmitted Diseases (STD) Control Branch has expanded syphilis screening recommendations for the prevention of congenital syphilis. Additional recommendations include at least one screen for syphilis for all sexually active people who could become pregnant, with additional screening for those at increased risk.
“Ensuring syphilis screening among pregnant people (and timely treatment if positive) is a first step toward prevention of mother to child transmission of syphilis,” according to CDPH.
In order to address the increase in congenital syphilis, an expansion of adequate services must occur to ensure that more people are accessing prenatal care and are getting screened, as well as getting prenatal care earlier, before the third trimester. Expansion also includes implementing syphilis screenings for people who are or could become pregnant in other settings like jails and homeless encampments.
This article is published as part of the Commonwealth Health Equity Reporting Fellowship.
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