Here’s why cases of this dangerous disease have increased.
Rates of congenital syphilis — when syphilis is passed from a pregnant mother to her baby in utero — are the highest they’ve been in two decades.
The disease is potentially fatal for babies, but treatable. However, public health officials say that the trend is indicative of much deeper problems in the United States healthcare system.
For years the spread of congenital syphilis sometimes called newborn syphilis has been growing.
The number of cases reported has increased every year since 2012, with a total of 918 in 2017, according to a new report by the Centers for Disease Control and Prevention (CDC). The national rate was 23.3 cases per 100,000 live births, a more than 150 percent increase since 2013 (9.2 cases per 100,000 live births).
The rising rates parallel those of other STIs in the United States, which have surged in recent years. The numbers of cases of chlamydia, gonorrhea, and syphilis have all risen every year for the past four years, leading to a record-breaking 2.3 million cases in 2017: the most ever reported nationally in a single year.
“My concern is that syphilis shows up before HIV usually. We used to say, years ago, that if I start to see a rise in syphilis that a rise in other STIs will follow,” said Dr. Jill Rabin, co-chief, division of Ambulatory Care and Women’s Health Programs-PCAP Services, Northwell Health in New York.
She and others have described syphilis as a “canary in a coal mine” for STIs because of its shorter window period for diagnosis, meaning it can show up much more quickly during screening.
When you see rates of syphilis going up, you’re bound to see the rates of other STIs, including HIV, going up as well.
An extension of climbing STI rates is the potential for these diseases to be passed on to babies.
Congenital syphilis can result in miscarriage, stillbirth, or death shortly after birth. When a baby does survive the birth, they can arrive underweight and premature. According to the CDC, effects of the disease can also include:
- deformed bones
- neurologic problems and brain damage
“Syphilis has been known to affect every single organ in the body,” said Dr. Jeffrey Klausner, clinical professor of medicine in the division of infectious diseases at the David Geffen School of Medicine at UCLA and adjunct professor of epidemiology at UCLA Fielding School of Public Health.
And babies may be born with no apparent symptoms at all. In some cases signs of serious health problems may not appear for weeks or even years later.
In addition to the danger posed to the baby, public health officials say that growing rates of congenital syphilis also mark a dangerous lapse in the healthcare system.
“When we see increase in congenital syphilis we know that there are much deeper systemic problems in our ability to prevent and control STDs, and that’s because congenital syphilis is one of the most easily preventable conditions with an effective public health system,” said Klausner.
Syphilis screening is a standard part of prenatal care, typically administered in the first trimester of pregnancy and often again in the third trimester.
Congenital syphilis represents not only a failure in terms of safe sex procedures allowing the disease to spread between partners, but also in care for pregnant mothers as well.
Though this isn’t entirely the fault of doctors. Rabin points out that it’s possible that some moms may not be seeking out prenatal care. But even moms that do need to confirm with their doctor that they’re being screened for syphilis as protocol for testing may vary.
“Do not assume the doctor will test you for everything you’re supposed to be tested for and ask the doctor what you are supposed to be tested for,” said Klausner.
Pregnant women need to ensure they’re being tested and treated appropriately because once the disease passes through the placenta, “the damage in a large part has been done,” said Rabin.
Syphilis remains highly treatable with antibiotics, and the fact that it is rebounding is troubling.
“Syphilis is incredibly amenable to effective public health programs but it takes money, it takes investment, it takes resources,” said Klausner.
Medical professionals, including Klausner, have documented a notable decline in public health spending in the United States in recent years. Certain higher risk groups for syphilis, including blacks and gay men, are disproportionately affected by the disease and likely hit harder by lapses in public health spending.
As far as prevention is concerned, both Rabin and Klausner recommend condom usage to prevent the spread of syphilis and other STIs between partners (although condoms do not provide complete protection). Limiting sexual partners and knowing the sexual history of partners is also important.
As noted above, appropriate prenatal care is also essential to ensuring that syphilis does not result in congenital syphilis occurring in a baby.
“There are great gaps in our ability in many jurisdictions to do that very basic public health work and then infected women fall through the cracks and don’t learn of their test results and doctors are not notified of that positive test result, and then the woman goes untreated,” said Klausner.
Cases of congenital syphilis have increased every year since 2012, with a total of 918 in 2017, according to a new report by the CDC. The national rate was 23.3 cases per 100,000 live births, a more than 150 percent increase since 2013 (9.2 cases per 100,000 live births).
The disease can cause miscarriage, stillbirth, and other problems during pregnancy. In infants it can result in blindness, meningitis, and anemia among other conditions.
Experts say the increase has come as a variety of STIs are increasing across the nation. While syphilis can be cured with antibiotics, if it is not caught early in pregnancy it can be extremely harmful to both mother and child.