Gaps in prenatal testing and treatment contributed to more than half of newborn syphilis cases in 2018, according to a new U.S. Centers for Disease Control and Prevention (CDC) report.
Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum, a type of bacteria. Pregnant women who have syphilis can pass the infection to their children during pregnancy. In newborns, the infection is called congenital syphilis.
Congenital syphilis rates increased by more than 261% during 2013-2018. In 2018, 28% of cases were because of a lack of timely prenatal care, while 31% of cases were because pregnant women didn't get appropriate treatment despite a diagnosis, according to the report published June 5, 2020 in Morbidity and Mortality Weekly Report. The report also notes the rising numbers of newborn deaths from syphilis. In 2018, 94 of the 1,306 infants born with syphilis died of causes related to their infection, a 22% increase from 2017.
Prenatal syphilis testing is important because symptoms of syphilis are not always apparent and testing can diagnose the infection. Pregnant women diagnosed with syphilis can be treated with a regimen of penicillin to reduce the risk of spread to their children. Left untreated, syphilis can lead to loss of pregnancy or infected newborns, who may not have noticeable signs of the disease at birth. If left untreated, congenitally infected infants can eventually develop cataracts, deafness, developmental delays, seizures, and death.
The CDC report emphasizes that the burden of the disease falls disproportionately on women and infants of color. Nearly 40% of mothers who gave birth to babies with syphilis in 2018 were black—even though they only made up about 15% of deliveries—and nearly 32% were Hispanic. Syphilis rates also vary by region. They are highest in the South and West but have been rising across the nation, especially in rural areas of the Midwest and West.
To reduce the number of cases of congenital syphilis, the report calls for universal screening of pregnant women at the first prenatal visit, preferably in their first trimester. Pregnant women with risk factors for syphilis or who live in areas where syphilis infections are more common—regardless of their individual risk factors—should be retested at 28 weeks of pregnancy and again at delivery. Some states already have statutes and regulations to test all pregnant women for syphilis in the third trimester and/or at delivery.
Antibody (serology) blood tests, which detect an individual's immune response to the bacteria, are used to screen for syphilis. If the screening test is positive, additional but different antibody tests are used to confirm the infection. (For details, see the article on Syphilis Tests.)
In addition to adequate screening, congenital syphilis cases can be reduced by making sure that pregnant women with positive results are notified in a timely manner and that they and their partners can get adequately treated as soon as possible.
CDC's report calls on public health authorities, healthcare organizations, providers, and policymakers to work together on intervention strategies. One approach is to establish congenital syphilis case review boards in local jurisdictions to identify prevention failures and solutions. "Differences in missed opportunities noted among regions and among racial/ethnic groups within regions demonstrate that tailored prevention efforts are needed," the CDC report added.
Release of the CDC report came as the COVID-19 pandemic strained the nation's public health system. In many communities, public health staff normally contact people who have tested positive for sexually transmitted diseases, make sure they get treatment, and interview them confidentially about who they have had sexual contact with to ensure those individuals also get testing and treatment. But many of these staff, along with doctors and nurses who provide care, have been reassigned to the COVID-19 response. Clinics are reducing hours and limiting appointments, no longer accepting walk-in patients, reducing services, or suspending outreach activities.
To spur local interventions, the CDC's Division of STD Prevention is supporting the National Association of City and County Health Officials' (NACCHO) new plan for reducing rates of congenital syphilis and syphilis among pregnant women and women of child-bearing age. The plan aims to improve testing during pregnancy and treatment for mothers who test positive. Supported work will also develop interventions that can be adapted to communities across the U.S.