Rate of newborns with syphilis hits decade-high

Some men are born for either greatness or infamy; Charles VIII of France, Hernán Cortés, Adolf Hitler, Benito Mussolini, Ivan the Terrible, Idi Amin, Leo Tolstoy, Franz Schubert, Arthur Schopenhauer, Édouard Manet, Friedrich Nietzsche – all of whom have been at least suspected to have contracted syphilis and maybe even gone mad as a result. Others are just born with congenital syphilis (CS), like Dutch Golden Age painter and art theorist Gérard de Lairesse who lost his sight and sported a saddle nose – as seen on Rembrandt’s portrait of him – as consequences of the infection.

 Whether the 458 babies born with CS last year in the United States will go down in history as great men and women has yet to be seen – except for the 33 that were stillborn or died shortly after birth, whose fates are sadly already known. Either way, the 2012-14 period will have the dubious honor of having the highest rate of newborns with CS in more than 10 years – 38% according to the Morbidity and Mortality Weekly Report released by the CDC on November 13th (the date is probably just a coincidence).  The steep increase starkly contrasts the falling rates of CS observed from 2008 to 2012, and is a reflection of rising syphilis rates among men and women.

Although the overall number of cases – 11.6 per 100,000 births – is statistically small, “these cases are entirely preventable, so 458 cases is 458 cases too many,” said CDC epidemiologist Virginia Bowen. “Congenital syphilis is a needless tragedy, and we need to be doing a better job of protecting newborn babies from this dangerous infection.” CS can lead to serious complications including death. “Up to 40 percent of babies will die in utero or shortly after delivery,” Bowen said. “Or they might have severe illness like blindness or deafness or other types of damage.”

It’s difficult to pinpoint the cause or causes behind the surge in CS cases, though “we think this increase in congenital syphilis is mirroring the trends we are seeing in syphilis among women,” said Bowen. In good theory, the mothers of the 458 newborns with syphilis should have had prenatal care, including testing for the sexually transmitted infection in the 1st trimester – the harsh reality is, though, that 22% of those women didn’t have any prenatal care at all; among women who had at least one prenatal visit, 43% were not treated for syphilis, even though about half were diagnosed with it; and 15% were never tested for syphilis during pregnancy.

According to Bowen, “the declines in syphilis gave us confidence that we had been doing a good job,” but “the fact that these women slipped through the cracks and their babies were born with syphilis tells us that something went wrong.” That something may be poor access to prenatal care for certain segments of the population. “African-American women are more disproportionately affected by syphilis than any other race,” maternal-fetal medicine physician at Ben Taub Hospital and Baylor College of Medicine in Houston Dr. Martha Rac, who was not involved in the report, said. “It seems to be the common theme that women having congenitally infected babies overwhelmingly have, if any, late, poor prenatal care. That is a big area which can be targeted from a public health standpoint.”

Some states have free healthcare for pregnant women. For example, “in California, every pregnant female has coverage for prenatal care [through the Medi-Cal program],” health officer for the Fresno County Department of Public Health Dr. Ken Bird said, but “many don't realize that, and they're not sure how to access that care.” Perhaps as a result of that ignorance, California went from 35 cases in 2012 to 99 in 2014. “In April, I designated Fresno County as an area of high syphilis, so providers are required to screen for syphilis three times during pregnancy,” Bird said.

Conversely, the previous syphilis rate decline may have led doctors to forgo testing, a theory posited by co-chief of ambulatory care in Women's Health Programs-PCAP Services at North Shore-LIJ Health System in New Hyde Park Dr. Jill Rabin. “We can't stop screening,” she said. “We have to remember that unless a couple is monogamous, it is important to screen for sexually transmitted diseases, including syphilis, especially if they are of reproductive age. We have to test so we can treat.”

But whatever the reason, “the only thing I can say is syphilis is going up right now across the board,” Bowen said. “From '13 to '14, we are seeing syphilis going up everywhere, including among the women, and we don't have the answers as to why.” Moreover, women may have syphilis and not know, making testing even more important – especially for women at higher risk, such as illicit drug users, ex-convicts and professional sex workers, as well as those living in areas with high rates of syphilis. This STI is treatable with penicillin. “If mom is treated at least 30 days before delivery, there's a 98 percent cure rate,” said Bowen. Additionally, transmission may be prevented by wearing a condom during sexual relations.

Related: Early symptoms of syphilis