The number of babies born with syphilis is rising at an alarming rate in Canada and the United States, an increase attributed by public health experts to increased methamphetamine use and lack of access to the public health system for indigenous people.
Reuters reports that while syphilis has made a global resurgence over the past five years, Canada is an outlier among wealthy nations in its rate of increase: 13-fold over five years, says Health Canada. The incidence of babies born with syphilis reached 26 per 100 000 live births in 2021, the most recent year available, according to the Health Canada data.
Babies with congenital syphilis are at higher risk of low birth weight, bone malformations and sensory difficulties. While syphilis in pregnancy is the second-leading cause of stillbirth worldwide, experts say congenital syphilis is easily preventable if an infected person is given penicillin during pregnancy.
Among the G7 group of wealthier nations for which data are available, only the US had a higher incidence of syphilis at birth: 74 per 100 000 live births in 2021, triple the rate in 2017, according to preliminary figures from the US Centres for Disease Control and Prevention (CDC).
There were 2 677 cases of congenital syphilis in the US in 2021 for a population of 332m, while Canada had 96 cases for a population of 38m.
Poverty, homelessness and drug use, are all drivers in the spread of the disease through unsafe sex, which women passed to their babies, public health researchers said.
“In high-income countries you see it in pockets of disadvantaged populations,” said Teodora Elvira Wi, who works in the WHO’s HIV, hepatitis and sexually transmitted infection programme.
“It's a marker of inequality – of low-quality prenatal care.”
What sets Canada apart is its indigenous populations who experience discrimination and often have poor access to health and social services, said Sean Rourke, a scientist with the Li Ka Shing Knowledge Institute at St Michael’s Hospital in Toronto, who focuses on prevention of sexually transmitted disease.
Health Canada said it has dispatched epidemiologists to help provinces contain the increase in congenital syphilis. Spokesperson Joshua Coke said the federal government is expanding testing and treatment access in indigenous communities.
‘Multiple failures’
A lot needs to go wrong for a baby to be born with syphilis, said Jared Bullard, a Manitoba paediatrician who has been researching babies born with syphilis since 2021 in an ongoing study for the Public Health Agency of Canada.
“It’s pointing at multiple failures along the path,” he said.
Saskatchewan has launched a public awareness campaign urging people to practise safe sex and get tested, said Dale Hunter, a spokesperson for the provincial Health Ministry. The province had an incidence of 185 cases of congenital syphilis per 100 00 live births in 2021.
In preliminary results of a study of 165 infants exposed to syphilis, Bullard and fellow paediatrician Carsten Krueger found at least two-thirds were born to women reporting a history of substance abuse.
Public health researchers and clinicians said the rates of congenital syphilis began increasing before the pandemic and worsened as public health agencies diverted resources to Covid-19 testing and other pandemic-related health measures.
This month Health Canada approved a syphilis and HIV test that can provide results in less than a minute, allowing providers to begin treatment immediately.
Some public health researchers and providers are urging the Canadian Government to buy and distribute the tests.
The United States is equally concerned about the alarming spread of the disease across the country, and the prevalence of congenital syphilis.
A decade ago, the US stood on the brink of eliminating the scourge of babies born with syphilis. Now, cases are surging, particularly within the black community.
The spike – as in Canada, driven in part by the nation’s drug and homelessness crisis – is especially apparent across the Sun Belt, says the CDC.
The Sun Belt comprises the southern tier of the US, including the states of Alabama, Arizona, Florida, Georgia, Louisiana, Mississippi and New Mexico.
The rate of syphilis is five times higher for babies born to black mothers than to white mothers, reflecting the racial disparities in access to maternal healthcare, reports The Washington Post.
In 2021, congenital syphilis resulted in 188 stillbirths and 23 infant deaths. While the overall number of infected infants seems low – nearly 2 700 nationally in 2021, or 74 of every 100 000 live births – officials say no baby in developed nations should be born with syphilis because most cases are preventable with testing and penicillin treatment of the mother
Now, public health authorities are striving to reach women at highest risk for passing syphilis to their babies – the homeless, prostitutes and drug users are more likely to be exposed to the disease, less likely to seek prenatal care.
STIs are rising, but public health is shifting away from condom promotion.
The first step to saving a baby from being born with syphilis is identifying whether the mother is infected. But just a few states require the most comprehensive syphilis testing covering the first visit, third trimester and at delivery.
The CDC, in examining congenital syphilis cases from 2020 with medical histories available, found 41% had no timely prenatal care or testing. Nearly as many were diagnosed with syphilis but did not receive adequate treatment.
When a pregnant woman tests positive for syphilis, the only recommended treatment to prevent a congenital case – Bicillin L-A – can be hard to come by. Pfizer is the only manufacturer, and there’s no generic version. It’s so expensive that pharmacies and private health providers often don’t stock it. Public Health Departments are the most likely to have the shots available.
In rare cases, patients who did receive timely testing and treatment still risk passing the infection to their babies.
Most women do not know they have syphilis because it doesn’t hurt, doesn’t burn, doesn’t itch. Any symptoms that develop are often vague and can be missed by even the most astute physician.
Joseph Kanter, Louisiana’s top health official, says he has treated patients with congenital syphilis in their family because of the infamous Tuskegee experiments, in which hundreds of black men were left untreated for syphilis to study the long-term effects of the disease. That has created a tragically ironic situation: the failure to treat syphilis in black adults made their descendants more sceptical of a medical system that could provide treatment to prevent syphilis in black babies.
“The issue of congenital syphilis is deeply intertwined with a history of institutional racism,” Kanter said, noting that 65% of congenital syphilis cases in Louisiana are among black babies. “We are dealing with a lot of earned mistrust.”
Public health experts say the country has the capability to end congenital syphilis, often drawing parallels to transmission of HIV from mother to child – which declined from 1 760 in 1991 to fewer than 40 in 2019. That plunge resulted from a national public health campaign with funding to adopt universal screening, put doctors on alert and ensure pregnant women with HIV received antiretroviral therapy and did not breastfeed.
“The same focus has not been on congenital syphilis,” said Rebekah Horowitz, director of STI programmes at the National Association of County and City Health Officials. “Without the focus and the funding, it won’t end.”
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