Newborn Syphilis Cases Soar Amid ‘Missed Opportunities’ in U.S. | Healthiest Communities Health News

U.S. health officials are sounding the alarm over a rapid rise of congenital syphilis cases during the past decade, calling for improved testing and treatment as the data highlights the country’s ongoing epidemic of sexually transmitted infections.

More than 3,700 cases of congenital syphilis occurred in the U.S. in 2022, according to a report released Tuesday by the Centers for Disease Control and Prevention. Congenital syphilis occurs when a mother passes a syphilis infection to her baby, and can cause poor health outcomes ranging from miscarriage, stillbirth and a newborn’s death to medical complications for a child such as blindness, hearing loss and bone malformations.

The congenital syphilis case total for 2022 represents a 32% increase over the count in 2021 and a number more than 10 times higher than the total for 2012. Among the 3,761 cases last year were 231 stillbirths and 51 infant deaths.

The new report indicates a lack of timely testing and adequate treatment during pregnancy contributed to close to 90% of congenital syphilis cases in 2022. In more than half of cases overall, the mother received timely testing, defined as being screened at least 30 days prior to giving birth, with no evidence of a diagnosis later than that window. Yet among that group, close to 70% received inadequate treatment and another 19% received no treatment or their treatment was not documented. Close to 4 in 10 infants with congenital syphilis were born to people who had not received any prenatal care.

The largest share of congenital syphilis infections was reported among Southern states, which collectively accounted for 1,981 cases, followed by 1,157 cases among states in the Western U.S. No testing or nontimely testing was tied to more than half of congenital syphilis cases in the West, with inadequate treatment accounting for the majority of what researchers called “missed opportunities” to prevent congenital syphilis cases in the South.

The report also found 72% of the U.S. population in 2021 lived in counties that had rates of primary or secondary syphilis infection among females 15 to 44 years old that were above the federal government’s Healthy People 2030 goal of 4.6 cases per 100,000 people. Researchers noted as well that increases in congenital syphilis paralleled trends in primary and secondary syphilis among women of reproductive age, with cases rising by nearly 700% among this group from 2012 to 2021.

“Historically, syphilis screening and interventions have targeted individual risk factors, but for many sexually active persons, their most significant risk factor is living in a community with high rates of syphilis,” the CDC report says. “In counties with a rate that exceeds (the federal goal), offering syphilis testing to sexually active females aged 15–44 years and their sex partners might help identify syphilis cases and prevent spread … and reduce congenital syphilis.”

Congenital syphilis rates in 2022 were at their highest level in three decades, according to the report. The surge comes amid an overall rise in sexually transmitted diseases, with previous CDC data showing more than 2.5 million cases of chlamydia, syphilis and gonorrhea in 2021.

In a call with reporters Tuesday, Dr. Debra Houry, the CDC’s chief medical officer, also said the new numbers mark “missed opportunities” to intervene.

“CDC is urgently calling attention to the need for health care providers, public health systems and communities to step up their efforts to address newborn syphilis,” Houry said. “These efforts must reach people where they are so that every mother and baby can get the help that they need to stay healthy.”

By race and ethnicity, the new report found the highest number of congenital syphilis cases in 2022 occurred among infants of Black and Hispanic birth parents, with 1,122 and 1,104 reported cases, respectively, followed by 1,034 cases among babies born to white women. Data from 2021 shows congenital syphilis cases occurred among babies of American Indian or Alaska Native mothers at a rate over 9 times higher than that of babies born to white mothers.

Inadequate treatment was the most prevalent cause of missed opportunities to prevent congenital syphilis among infants of Black and Hispanic parents, while no testing or nontimely testing accounted for the highest prevalence of missed prevention opportunities for infants born to birth parents who were American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and white.

Dr. Laura Bachmann, chief medical officer in the CDC’s Division of STD Prevention, said Tuesday that socioeconomic factors such as a lack of health insurance, transportation limitations, poverty and living in communities that lack adequate maternal health and child care services have contributed both to the overall rise of congenital syphilis and to racial and ethnic gaps.

“These disparities stem from decades of deeply entrenched social factors experienced in daily life that create greater obstacles to high-quality health care services (and result) in health inequities,” Bachmann said.

A looming potential hurdle to stemming the rise in congenital syphilis is a shortage of medication to fight it. In June, drugmaker Pfizer announced the depleted availability of penicillin shots that are the only treatment recommended for pregnant women to prevent congenital syphilis. Bachmann said CDC guidance prioritizes use of the medication for pregnant women due to the shortage, and Dr. Robert McDonald of the Division of STD Prevention said the CDC had not received any reports of people not being able to access it.

Bachmann also urged health care providers to conduct rapid syphilis testing and presumptive treatment after an initial positive test in mothers who may face access barriers to regular prenatal care services, and that testing be conducted in various health settings, including the emergency department, substance use disorder treatment facilities, and through maternal and child health programs.

“We must start thinking outside of the OB-GYN’s office,” Bachmann said. “Every encounter a person has with a health care provider during pregnancy can be an opportunity for prenatal care and testing for syphilis.”