The rise in sexually transmitted infections in the United States is alarming: More than 3,700 cases of congenital syphilis will be reported in 2022, nearly 11 times the number recorded a decade earlier, according to data released Tuesday by the Centers for Disease Control and Prevention. control and prevention.
Syphilis during pregnancy can lead to miscarriage and stillbirth, and babies who survive may be blind or deaf, or have severe developmental delays. In the year In 2022, the disease caused 231 infant deaths and 51 infant deaths.
About 90 percent of new cases could have been prevented with timely diagnosis and treatment, the agency said.
In an interview, Dr. Laura Bachman, chief medical officer of the agency’s sexually transmitted disease prevention division, said, “Syphilis in infants is on the rise, and the situation is dire.” “We have to do things differently.”
“One case is indicative of a breakdown in the public health infrastructure, and now we have 3,700 cases,” he added.
The system is divided in several ways. Of the 3,700 babies, 38 percent were born to women without prenatal care. About 30 percent of women who had at least one prenatal appointment did not get a syphilis test or were diagnosed too late.
And 88 percent of those diagnosed with syphilis received inadequate, undocumented, or no treatment.
Public health departments had teams of disease-intervention specialists and nurses to make sure pregnant women were tested and treated — even if that meant getting shots at home — and to track all their communications, said Dean Dr. Thomas Dobbs. from the University of Mississippi John D. Bower School of Public Health.
But those departments have suffered over the years.
“You can’t destroy public health infrastructure and expect bad things to happen,” Dr. Dobbs said. “I can’t believe we’re in this state of health in a country as rich as ours.”
Calling the rise in syphilis a “shameful crisis” fueled by funding cuts and bureaucratic hurdles, the National Coalition of STD Directors on Tuesday called for $1 billion in federal funding and a White House syphilis response coordinator to curb the crime.
Syphilis was nearly eliminated in the United States 20 years ago, but has increased by 74 percent, to 177,000 cases between 2017 and 2021. Other sexually transmitted diseases are also on the rise: in 2021, 1.6 million cases of chlamydia and more than 700,000 cases of gonorrhea.
Even before the outbreak, the numbers were rising, but over the past few years, a decline in routine preventive care, a shift to more telehealth appointments for prenatal care, and reduced clinic hours may have exacerbated the situation.
The reasons for the rise in congenital syphilis vary slightly from region to region. No diagnosis or too late testing accounted for 56 percent of cases in the West, and inadequate treatment accounted for 55 percent of cases in the South.
In Mississippi, people must drive hours to see an obstetrician, or may not have the transportation, work, or family circumstances to facilitate seeking health care.
“If you’re in a high-poverty state like Mississippi, where working-class people are really struggling to get by, everything is a barrier,” Dr. Dobbs said.
Nationally, one in five pregnant women with syphilis never received prenatal care, suggesting they tried it in another setting, such as an emergency room, prison or a needle exchange program.
This rate was even higher in Michigan, where one-third of all STDs were diagnosed in the emergency department. “More and more people are receiving what should be routine preventive health care in the emergency room,” said Dr. Natasha Baghdasarian, the state’s chief medical officer.
Because ER doctors don’t have long-term relationships with patients, “it’s easy for people to fall through the cracks,” she says.
Syphilis has been on the rise primarily among men who have sex with men, but in recent years it has also made inroads into heterosexual relationships. Syphilis tests among women of childbearing age It will rise by 17.2 percent between 2021 and 2022, according to the new report.
But public health departments don’t have the same relationship with community organizations that help gay and bisexual men prevent HIV and STDs.
“There is a lack of awareness among women of childbearing age that syphilis still exists and affects them and what the consequences are for their unborn child,” Dr. Baghdasarian said.
Pregnant women may not have symptoms or may not know they need testing or treatment.
The CDC recommends testing for syphilis at the first prenatal visit or as soon as pregnancy is diagnosed. For women who are at risk for the disease because of where they live, substance use, or sexual behavior, the CDC recommends two additional screenings: at 28 weeks of pregnancy and at delivery.
Many states go further by mandating that all pregnant women be screened for the infection within three trimesters. This is because women who test negative early in pregnancy are more likely to contract syphilis later.
“They may be at higher risk because they don’t use protection like condoms,” said Dr. Melanie Taylor, a medical epidemiologist at the Maricopa County Department of Public Health in Arizona.
Prevention efforts should extend beyond prenatal care to pregnant women and reach their partners as well as other gay men and women, Dr. Taylor said.
Maricopa County has some of the highest congenital syphilis rates in the nation. About half of women who gave birth to babies with syphilis in the county did not receive prenatal care by 2022. Drug use, particularly fentanyl and methamphetamine, and recent arrests are major contributors, Dr. Taylor said.
The county is working with hospitals and community organizations to reach women who use drugs, have recently been incarcerated, have unstable housing or are otherwise at risk of contracting syphilis.
The public STD clinic, which serves up to 35,000 patients a year, charges patients and their partners $20 for screening and treatment and waives the fee if the cost is a barrier.
Confirming a syphilis diagnosis usually takes two positive tests, but the CDC recommends that providers treat women who cannot return after a single positive test.
Early syphilis in a pregnant woman can be treated with a single shot. In June, Pfizer warned The Food and Drug Administration had a shortage of bacilli, in part because demand for the treatment of syphilis was increasing dramatically.
The CDC urges health care providers to prioritize the use of bacilli for pregnant women with syphilis. The only alternative is doxycycline, which must be taken twice a day for several weeks and is not recommended for pregnant women.
The new study was conducted before the drug shortage, so the medical figures this year may be worse.
More options for treatment, especially affordable ones, can alleviate issues, such as vaccines and better diagnostics. “Syphilis diagnostic technology has not changed much in many, many, many decades,” Dr. Bachmann said.
“There’s a lot of room for work here,” she said. “It’s clear we have a broken system.”