The rise in sexually transmitted infections in the United States has taken a particularly tragic turn: more than 3 700 cases of congenital syphilis were reported in 2022, roughly 11 times the number recorded a decade ago, according to the Centres for Disease Control and Prevention (CDC).
Syphilis during pregnancy can lead to miscarriage and stillbirth, and infants who survive may become blind or deaf, or have severe developmental delays. In 2022, the disease caused 231 stillbirths and 51 infant deaths.
Nearly 90% of the new cases could have been prevented with timely testing and treatment, according to the agency.
“Syphilis in babies continues to increase, and the situation is dire,” Dr Laura Bachmann, chief medical officer at the agency’s division for prevention of sexually transmitted diseases, told The New York Times.
“We need to do things differently.
“One case is an indication of a breakdown in the public health infrastructure, and now we have 3 700 cases,” she added.
The system breaks down in multiple ways. Nearly 38% of the 3 700 babies were born to women who received no prenatal care. Of those who had at least one prenatal appointment, 30% were never tested for syphilis or were tested too late.
And among those who tested positive for syphilis, 88% received inadequate, undocumented or no treatment.
Public health departments used to have teams of disease-intervention specialists and nurses who made sure pregnant women were tested and treated – even if that meant giving them shots in their homes – and traced all of their contacts, said Dr Thomas Dobbs, dean of the University of Mississippi’s John D Bower School of Population Health.
But those departments have been gutted over the years.
“You can’t dismantle the infrastructure of public health and not expect bad things to happen,” he said. “I can’t believe that we’re at this state of health in a country as wealthy as we are.”
Calling the rise in congenital syphilis “a shameful crisis” accelerated by funding cutbacks and bureaucratic obstacles, the National Coalition of STD Directors this week demanded $1bn in federal funding and a White House syphilis response co-ordinator to stem the tide.
Syphilis was nearly eliminated in the country about 20 years ago, but rose by 74%, to 177 000 cases, between 2017 and 2021. Other STIs are also on the rise: in 2021, there were 1.6m cases of chlamydia and more than 700 000 cases of gonorrhea.
The numbers were rising even before the pandemic, but in the past few years, a drop in routine preventive care, a shift to more telehealth appointments for prenatal care, and reduced clinic hours may have exacerbated the situation.
The reasons for the increase in congenital syphilis varied a bit by region. No testing, or testing too late, accounted for 56% of cases in the West, and inadequate treatment caused 55% of cases in the South.
In Mississippi, people may have to drive for hours to find an obstetrician, or they may not have the transportation, job or family situation to facilitate seeking health care.
“If you’re in a really poverty-endemic state like Mississippi, where working-class folk are struggling to get by, everything is a barrier,” Dobbs said.
Nationwide, about one in five pregnant women who were diagnosed with syphilis did not receive any prenatal care, suggesting they were tested in another setting, such as an emergency room, prison or needle-exchange programme.
That proportion was higher in Michigan, where about a third of all STIs were diagnosed in emergency departments. “More and more people are receiving what should be routine preventive health care in emergency departments,” said Dr Natasha Bagdasarian, the state’s chief medical executive.
Because ER doctors do not have longstanding relationships with the patients, “it’s easier for people to fall through the cracks”, she said.
Syphilis was resurging primarily among men who have sex with men, but in recent years it has crept into heterosexual networks. Among women of reproductive age, syphilis diagnoses rose by 17.2% between 2021 and 2022, according to the new report.
But public health departments are not as well connected to heterosexual women as they are to community organisations that help gay and bisexual men with HIV and STI prevention.
“There’s a lack of awareness among women of childbearing age that syphilis is still around and that it can affect them and what the consequences could look like for their unborn child,” said Bagdasarian.
Pregnant women may not have symptoms nor realise they need to be tested or treated.
The CDC recommends screening for syphilis at the first prenatal visit or as soon as pregnancy is identified. For women at high risk of infection because of where they live, substance use or sexual behaviour, the CDC suggests screening twice more: at 28 weeks of gestation and at delivery.
Many states go further, mandating that all pregnant women be tested for the infection at all three time points. That’s in part because women who test negative early in pregnancy may acquire syphilis later on.
See more from MedicalBrief archives:
Concern as syphilis cases in babies, women, skyrocket in Canada and US
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