Last year, over 600 pregnancies in the United States were affected by syphilis. Of those, 45 babies were either stillborn or dead within the first month of life, while many others may have been born with serious defects, some of them irreversible.
While these cases represent a tiny fraction of the approximately 3.9 million births that occurred in the U.S. in 2016, public health experts say that they’re a sign that something is deeply flawed about prenatal health care in the country, and that not a single one of these pregnancies needed to be marred by syphilis, a treatable and preventable sexually transmitted disease.
“When you have congenital syphilis occurring, it means there has been a breakdown in the whole medical system ― that these cases are not being diagnosed until a baby is born, when they should be diagnosed antenatally or even before then,” said Dr. Amesh Adalja, spokesman for the Infectious Diseases Society of America and a senior associate at the Johns Hopkins Center for Health Security. “It’s unfortunate that we’re seeing a resurgence of a disease that should basically be gone.”
“When you have congenital syphilis occurring, it means there has been a breakdown in the whole medical system.”
Syphilis is a bacterial infection that can be treated easily with antibiotics, but can cause sores, rashes, dementia and blindness if left untreated. In addition to causing miscarriages and stillbirths, babies who contract it in the womb can be born blind, deaf, or have deformed bones, skin rashes and enlarged livers and spleens.
It was on the brink of extinction in the U.S. just 10 years ago, but today is surging. Cases of congenital syphilis, which is when a fetus contracts an infection from the mother in the womb, rose 28 percent last year ― from 492 in 2015 to 628 in 2016.
The spike mirrors a record high number of STDs in the U.S. in general. Officials recorded more than two million cases of chlamydia, gonorrhea and syphilis last year (although officials estimate the true number is around ten times as much) and young people made up the bulk of the infections. For syphilis specifically, of which there were 28,000 reported cases, rates among women increased by 36 percent.
“Each case of congenital syphilis is a sentinel event reflecting numerous missed opportunities for prevention within the public health and health care system,” said Dr. Sarah Kidd, of the U.S. Centers for Disease Control and Prevention’s division of STD prevention. “These missed opportunities can include women who fell out of the system, either due to poverty, a lack of health insurance or other contributing factors.”
According to the CDC, about half of moms who give birth to babies with congenital syphilis either had prenatal care late in their pregnancy, or no prenatal care at all. Fifteen percent of them were initially tested for syphilis early in pregnancy but then contracted it afterward. Still others may have tested positive for syphilis but dropped out of prenatal care before receiving positive results or starting antibiotic treatment.
But more broadly, the U.S. is seeing more congenital syphilis cases because there are more syphilis cases in general ― especially among women of reproductive age, Adalja points out. Some people may have the bacterial infection but not have any symptoms, so it’s up to doctors to make STD testing a routine part of prenatal care.
“We know how to treat these sexually transmitted infections, from chlamydia to gonorrhea to syphilis,” he said. “But you have to diagnose them in order to do that, and it has to be done very routinely, the way that some people get tested for blood pressure.”
Indeed, both the CDC and the American Congress of Obstetricians and Gynecologists recommend that STD testing be a routine part of prenatal care in the first trimester, and that women who have multiple sexual partners, a partner with STDs or who live in an area with high rates of syphilis be tested again later on in the pregnancy.
Despite these recommendations, a recent CDC analysis of 2013 data found that only 85 percent of privately insured women had a syphilis test while pregnant. Another CDC analysis found that among women who had stillbirths in 2013, about 35 percent of women on Medicaid and 30 percent of women with private insurance had no syphilis testing, either during the pregnancy or at the stillbirth, and that syphilis testing among all women after stillbirth was less than 10 percent, suggesting that stillbirths caused by congenital syphilis could be underreported.
Improving access to maternal care for the poorest and most vulnerable women in the U.S. would help close some of these gaps in care, but Adalja points out that shame, fear and misunderstanding about STDs are still major medical barriers, even for doctors who may decide not to test a prenatal patient for STDs because she doesn’t “seem” at risk.
“Physicians have to be more in tune to the risks of syphilis and realize this hasn’t gone away,” he said.