By Michelle L. Allen
Maternal and Child Health Director, Georgia Department of Public Health
By William (Bill) Smith
Executive Director, National Coalition of STD Directors (NCSD) and Senior Faculty Fellow, Robert Wood Johnson Center for Health Policy, University of New Mexico
For the first time in nearly a decade, all three commonly reported sexually transmitted infections (STIs) – chlamydia, gonorrhea, and syphilis – are on steep inclines. The resurgence of syphilis, in particular, has been quite significant with three straight years of double digit increases. No demographic has escaped these increases in syphilis, including women. As a result, we are also witnessing an increase of congenital syphilis which increased 38 percent between 2012 and 2014 according to data released by CDC. Four jurisdictions made note of the rising rates of syphilis related to maternal and child health (MCH) outcomes in their FY16 Title V MCH Block Grant Applications.
Congenital syphilis occurs when a pregnant woman passes the infection to her fetus during the pregnancy. The results of congenital syphilis can be quite severe. According to the CDC, up to 40 percent of babies born to women with untreated syphilis and who contract the infections may be stillborn births or die from the infection as a newborn [www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm]. Babies born with the infection can also have deformed bones, severe anemia, enlarged liver and spleen, meningitis, jaundice, and nerve problems, including blindness and deafness. Given the severity of congenital syphilis and the increasing number of cases seen across the country, we must do everything possible to prevent mother-to-child transmission.
We are authoring this article jointly because we believe that in the face of the steep increases in congenital syphilis cases in the United States, state, territorial, and local health department maternal and child health (MCH) programs and STD programs can work together to reverse the trend.
So what can be done?
- Ensure that providers of care for pregnant women are following CDC guidelines which recommend pregnant women be screened for syphilis during their first prenatal visit and ideally, routinely as part of a routine prenatal panel, along with HIV and other infectious diseases. Additionally, the CDC recommends additional screening in the third trimester and at delivery for women who are at increased risk of syphilis; who live in areas with a high number of syphilis cases; and for women not tested or who had a positive syphilis test when initially screened.
- Consider, based on case rates in your jurisdictions, policy changes to support additional screening beyond the CDC recommendations may make sense. For example, while most states have laws that require syphilis screening during the first trimester of pregnancy, several states have more added third trimester screening. From 2014-2015, Louisiana, Georgia, and Texas all added third trimester syphilis screening to state laws.
Health department programs should work closely with providers to ensure that all pregnant women who test positive for syphilis are treated without delay. Recent evidence suggests that nearly 70 percent of congenital syphilis cases in 2014 were actually among women who received some prenatal care while pregnant. Some of these women accessed care late in their pregnancy, receiving treatment for their syphilis less than 30 days before delivery, and therefore still count as a congenital case. Still, nearly 30 percent of all congenital syphilis cases in 2014 were among pregnant women who tested positive, but received no treatment and another 21 percent who received inadequate treatment [www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a3.htm].
A single case of congenital syphilis is one too many. Each is a sentinel event broadcasting a clarion call for all of us concerned about the reproductive and sexual health of pregnant women – as well as the health of their babies – to take action. Public health MCH and STD programs, working with providers and other partners, can create better outcomes and turn the tide on congenital syphilis.