LGBTQ Agenda: CDC sounds alarm about syphilis in newborns

  • by John Ferrannini, Assistant Editor
  • Tuesday November 14, 2023
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Dr. Jonathan Mermin, M.P.H., is the director of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention. Photo: Courtesy CDC
Dr. Jonathan Mermin, M.P.H., is the director of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention. Photo: Courtesy CDC

Syphilis cases in newborn babies have risen over 10 times the number reported a decade ago, and the federal Centers for Disease Control and Prevention is sounding the alarm with a new report.

According to "Vital Signs: Missed Opportunities for Preventing Congenital Syphilis," released November 7, a total of 3,761 cases of congenital syphilis were reported to the CDC in 2022, including 231 stillbirths and 51 infant deaths.

"Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis," the report concluded. "Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions."

Dr. Jonathan Mermin, M.P.H., director of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention, stated that the crisis is "unacceptable."

"All pregnant mothers — regardless of who they are or where they live — deserve access to care that protects them and their babies from preventable disease," he stated. "Our nation should be proactive and think beyond the OB-GYN's office and bridge prevention gaps. Every encounter a health care provider has with a patient during pregnancy is an opportunity to prevent congenital syphilis."

The CDC recommends all pregnant people be screened for syphilis at their first prenatal care visit. In all of the cases documented in the report, however, the mothers had either not been tested or had been tested inadequately.

It's a far cry from 1998, when the CDC initiated a drive to eliminate syphilis. The end of sustained transmission of the Treponema pallidum bacteria was actually considered possible because there were only 6,993 cases in the U.S. that year. Compare that to 2021, which saw 176,713 total cases — the worst year since 1950, according to CDC data.

Syphilis is spread by contact with infected lesions or sores. The primary stage of syphilis is the presence of a chancre, followed by a secondary stage that often involves rashes and swollen lymph nodes. It's in the third stage — after a latency period that can last over a decade — that syphilis can be fatal, sometimes involving damage to the central nervous system or the brain.

Syphilis was feared because it often was fatal until 1943, when the antibiotic penicillin became the first effective treatment. But after reaching that nadir around the turn of the millennium, syphilis rates have exploded, increasing 32% from 2020 to 2021 alone, according to CDC data.

Most U.S. syphilis cases occur in gay and bisexual men, and have for several decades. For example, in 2021, 63% of cases were among men who have sex with men, the CDC reported.

But as the B.A.R. previously reported, from 2014-18 cases in women suddenly rose 172.7%. UCSF's Dr. Ina Park theorized that this was related to the crystal meth epidemic.

"There has been a crystal meth epidemic in the Central Valley for years, with Fresno being a hotspot," Park told the B.A.R. in 2021. "Congenital syphilis infections are known to be associated with maternal meth/substance use, homelessness, lack of access to prenatal care, incarceration. So there is an intersection of the crystal meth epidemic with the rise of syphilis in women, which has led to increases in congenital syphilis."

She added, referring to this and the rise in congenital cases, that "these are things we didn't see 20 years ago."

In San Francisco, there have been two reported cases of congenital syphilis in 2023 through August 30 — the same number as 2022 through August 30 — according to the Department of Public Health's most recent sexually transmitted infection monthly report. In the same period there were 135 cases of syphilis in women out of 895 total cases (last year that was 134 cases of syphilis in women out of 1,204 total cases).

Dr. Julia Janssen from SF DPH's HIV/STI Prevention and Control Section told the B.A.R. that "since around 2017 we saw a rapid rise in syphilis in San Francisco in cis women" and that numbers have flatlined for the past four years.

"Since 2019 we have seen three to five cases of congenital syphilis per year," Janssen said. "We're very worried about congenital syphilis. The rise in congenital syphilis is largely driven by upstream social determinants of health," such as homelessness and health care access.

Janssen said that a task force is working on addressing this issue by increasing access to low-barrier pregnancy testing, linkage to prenatal care, syphilis screenings, case management, and treatment.

"For us even one case of congenital syphilis is too many and our goal is congenital syphilis elimination," she said.

As the B.A.R. previously reported, there's a shortage of Bicillin, the frontline treatment for syphilis. Janssen said that because it's the only treatment for those who are pregnant, those who aren't may be treated with doxycycline.

"That's an added challenge we have," Janssen said. "We have to make sure we have enough Bicillin so we can treat congenital syphilis — we may recommend other antibiotics to non-pregnant people."

LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact John Ferrannini at [email protected]

Due to the Thanksgiving holiday, the LGBTQ Agenda column will return Tuesday, December 5.

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