Syphilis in Newborns is a Growing Concern
The rise in congenital syphilis is a community burden, say Rollins experts.
By Shelby Crosier
In the past five years, rates of almost all sexually transmitted infections (STIs) have risen in the U.S., with over 2.5 million cases of chlamydia, gonorrhea, and syphilis being reported in 2022 alone. This is, in large part, due to interruptions in normal medical care and public health services during the COVID-19 pandemic.
“We’ve seen a huge rise in STIs post-COVID,” says Angela Bengtson, PhD, assistant professor of epidemiology. “People didn't have access to care, sexual behaviors might have changed, and sexual networks might have evolved. There might have been interruptions in access to screening and treatment. That’s all compounded, and now we have a larger amount of syphilis circulating in the population.”
Syphilis cases have seen the most rapid rise of all STIs, growing by over 80% since 2018. Most concerning is the dramatic increase in cases of congenital syphilis (when a fetus is infected with syphilis during pregnancy), which has increased ten-fold over the past decade. Georgia currently has the 16th highest rate of congenital syphilis in the nation, reporting 101 cases in 2022.
An Issue Driven by Disparities in Access
Congenital syphilis is preventable. The Centers for Disease Control and Prevention report that almost 90% of cases of congenital syphilis could be prevented with timely testing and treatment during pregnancy. Although pregnant people should be tested for syphilis during their prenatal care, 40% of babies born with syphilis in 2022 were born to mothers who had not received any care during their pregnancy. This points to challenges with access to prenatal care.
“There was no opportunity for testing in those instances, at least not in a prenatal care environment,” says Jessica Sales, PhD, associate professor of behavioral, social, and health education sciences. “That means that we need to think about creating opportunities outside of the health care system for reducing barriers, reducing stigma around testing, and just getting more individuals tested and treated for syphilis in a timely fashion.”
Some barriers individuals may face that keep them from receiving prenatal care include things like the high cost of prenatal appointments and lack of transportation, childcare, or health insurance (over 11% of women of childbearing age in the U.S. were uninsured in 2020). Pregnant people also face systemic barriers to prenatal care, such as limited availability of maternal health providers.
These barriers are especially important to address for pregnant people of color. Structural racism and inequities drive poorer maternal and child health outcomes for people of color, such as higher rates of maternal and infant mortality, and that includes higher rates of congenital syphilis. American Indian/Alaskan Native babies had the highest rates in 2022, followed by Native Hawaiian/Pacific Islander and Black babies.
“We know that communities of color, for various structural reasons, have historically not had the same ability to access quality prenatal care in their communities, where they could engage safely, comfortably, and without stigma,” says Sales. “There are a lot of structural factors in our health care system that are inhibiting timely engagement in testing and then treatment for syphilis.”
The Implications of Congenital Syphilis
Congenital syphilis can have major health consequences. If a pregnant person has untreated syphilis, they could experience pregnancy loss, stillbirth, or premature birth. Babies born with syphilis can experience low birth weight, jaundice, severe anemia, deformities in their bones, and brain problems that lead to blindness or deafness. Although these are sometimes present immediately after birth, they may also take time to develop, meaning the syphilis could go undetected and cause more damage.
“Congenital syphilis can present in a range of different ways and at different times,” says Bengtson. “For some babies, they'll start to have complications early on. For others, you might not see signs right away, especially if you didn't know that the mother had syphilis and that it had been passed on. We have treatments available, but avoiding negative health outcomes for children born with congenital syphilis depends on getting early and quick treatment for them.”
Overcoming Through Community Collaboration
Although high syphilis rates in pregnant women are alarming, they will not be improved by focusing on prevention for that population alone. The biggest risk factor for contracting syphilis is living in a county with high rates of syphilis, so prevention efforts should focus on whole communities.
“The best thing we can do to prevent syphilis during pregnancy is to prevent syphilis before pregnancy,” says Sales. “In the communities where there are high rates of syphilis, there are things we can do preventatively—and outside of OB-GYN offices—to engage people.”
This could mean working with providers at different points of the medical system—such as emergency departments or providers seeing patients for chronic conditions—to increase routine syphilis testing. It could also mean engaging stakeholders outside of health care, such as community-based organizations or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices, to promote testing. Increasing the availability and visibility of syphilis testing and treatment will also serve to normalize and lessen the stigma around testing.
Reducing the community burden of syphilis, and in turn congenital syphilis, will take collaboration. Health departments will need to identify the counties and communities with the highest syphilis rates and work with physicians and community organizations to make testing and treatment more accessible. Health care providers will have to talk with their patients about sexual health and make syphilis testing part of routine care, especially for pregnant people. And everyone working to address this problem will have to listen to the community.
“It’s important to take a step back and work with the community to understand where a good space and opportunity would be to reach people in a way that feels safe, so they can understand why this [syphilis testing] is being done and why it’s important,” says Sales. “Then we have to invite the different stakeholders, whether they be emergency rooms or WIC offices, to that conversation and think about the role they can play. When you start those conversations and bring the stakeholders together, you can start to get buy-in. It allows this to not fall on the shoulders of any one person in the health care landscape, but rather use everyone’s skills and strengths to work collaboratively.”
