CDC: Infant Syphilis Spike Continues

Syphilis case rates among U.S. newborns soared from 334 in 2012 to more than 3,700 last year, according to the CDC, which recommended “concerted action” to combat this largely preventable problem.

A graph accompanying the agency’s “Vital Signs” report showed a geometrically increasing rise in infants’ syphilis case numbers, which the authors, led by Robert McDonald, MD, of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, called one of “the consequences of a rapidly accelerating epidemic of sexually transmitted infections in the United States.”

Data for the report came from the CDC’s National Notifiable Diseases Surveillance System, which covers all 50 states, the District of Columbia, and territorial possessions.

Except for the specific numbers, the new report is almost a cut-and-paste copy of one the CDC put out in 2021, at which point the agency found a nine-fold increase in cases from 2012 through 2020. The new report indicated that the 2022 count represented a 32% increase from 2020.

These increases in newborn cases closely tracked case rates among reproductive-age women, which went from about two per 100,000 population in 2012 to 19 in 2022. From 2020 to 2022, case rates in women rose 18%.

That almost two-fold difference in rates of increase suggests many “missed opportunities” for detection and prevention, which the CDC focused on heavily.

Perhaps most importantly, the CDC noted that, in more than half of the congenital cases, infants’ mothers had tested positive for syphilis while pregnant but were not treated adequately. Some 38% of women whose babies were infected at birth had received no documented prenatal care whatsoever.

The agency commented that, overall, almost 90% of newborn cases could have been prevented with proper prenatal care, testing, and treatment.

CDC recommendations for addressing the epidemic included the following:

• Employ rapid syphilis tests wherever at-risk pregnant women may present, such as emergency departments, needle exchange sites, prisons and jails, and maternal/child health programs
• Clinicians should not necessarily wait for confirmation of positive results from rapid syphilis tests, but rather should consider starting treatment immediately if the patient “faces greater obstacles to ongoing care”
• Step up detection efforts prior to pregnancy in areas where syphilis is known to be endemic at high rates
• Work with others in the community to identify and overcome other barriers to testing and treatment

In a statement, Jonathan Mermin, MD, MPH, director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said, “Our nation should be proactive and think beyond the ob/gyn office and bridge prevention gaps. Every encounter a healthcare provider has with a patient during pregnancy is an opportunity to prevent congenital syphilis.”

On a call with reporters, Stephanie Taylor, MD, medical director of the Louisiana Office of Public Health STD, HIV, and Hepatitis Programs, described a multipronged approach that her state has followed with significant success.

A law passed in 2014 required that women in prenatal care be tested for syphilis unless they proactively refuse. As well, each case of congenital syphilis that does occur is then subjected to a comprehensive review, in which public health officials seek information on the circumstances to identify missed opportunities for prevention and barriers that the mother and her care providers may have faced.

This past August, the program has been expanded to include letters sent from the state health department to every provider who was involved in mothers’ care when infants are born with syphilis. These are general and informational, Taylor emphasized, not “pointed” or accusatory, the goal being to help providers consider syphilis prevention with future patients.

In all, she said, these and other efforts have helped Louisiana go from having the nation’s highest rate of congenital syphilis to now being ranked seventh — “still high,” Taylor noted, but an improvement.

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