An increasing number of babies are born with syphilis, a sign of a broader epidemic | ET REALITY


The rise in sexually transmitted infections in the United States has taken a particularly tragic turn: More than 3,700 cases of congenital syphilis were reported in 2022, about 11 times the number recorded a decade ago, according to data released Tuesday by the Centers for Disease Control and Prevention. Diseases. Control and Prevention.

Syphilis during pregnancy can cause miscarriages and stillbirths, and babies who survive may become blind or deaf, or suffer severe developmental delays. In 2022, the disease caused 231 stillbirths and 51 infant deaths.

According to the agency, nearly 90 percent of new cases could have been prevented with timely testing and treatment.

“Syphilis in babies continues to increase and the situation is dire,” Dr. Laura Bachmann, medical director of the agency’s sexually transmitted disease prevention division, said in an interview. “We need to do things differently.”

“One case is an indication of a collapse in public health infrastructure, and now we have 3,700 cases,” he added.

The system breaks down in multiple ways. Nearly 38 percent of the 3,700 babies were born to women who did not receive prenatal care. Of women who had at least one prenatal appointment, 30 percent never got tested for syphilis or got tested too late.

And among those who tested positive for syphilis, 88 percent received inadequate, undocumented, or no treatment.

Public health departments used to have teams of disease intervention specialists and nurses who made sure pregnant women were tested and treated (even if that meant vaccinating them at home) and traced all their contacts, said Dr. Thomas Dobbs. , dean. from the John D. Bower School of Population Health at the University of Mississippi.

But those apartments have been destroyed over the years.

“You can’t dismantle public health infrastructure and not expect bad things to happen,” Dr. Dobbs said. “I can’t believe we are in this state of health in a country as rich as us.”

Calling the rise in congenital syphilis “a shameful crisis” accelerated by funding cuts and bureaucratic obstacles, the National STD Directors Coalition on Tuesday demanded $1 billion in federal funding and a House syphilis response coordinator. White to stem the tide.

Syphilis was nearly eliminated in the United States about 20 years ago, but increased by 74 percent, to 177,000 cases, between 2017 and 2021. Other STIs are also on the rise: In 2021, there were 1.6 million cases of chlamydia and more than 700,000. cases of gonorrhea.

The numbers were rising even before the pandemic, but in recent years, a drop 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 increase in congenital syphilis varied somewhat by region. Lack of testing, or testing too late, accounted for 56 percent of cases in the West, and inadequate treatment caused 55 percent of cases in the South.

In Mississippi, people may have to drive for hours to find an obstetrician, or they may not have the transportation, job, or family situation to make it easier for them to seek medical care.

“If you’re in a really poverty-endemic state like Mississippi, where working-class people are really struggling to survive, everything is a barrier,” Dr. Dobbs said.

Nationally, about one in five pregnant women diagnosed with syphilis did not receive any prenatal care, suggesting they were tested in another setting, such as an emergency room, prison, or exchange program. of needles.

That proportion was highest in Michigan, where about a third of all STIs were diagnosed in emergency departments. “More and more people are receiving what should be routine preventive health care in emergency departments,” said Dr. Natasha Bagdasarian, the state’s chief medical officer.

Because emergency room doctors don’t have long-standing relationships with patients, “it’s easier for people to fall through the cracks,” he said.

Syphilis was resurfacing primarily among men who have sex with men, but in recent years it has infiltrated heterosexual networks. Among women of reproductive age, syphilis diagnoses increased 17.2 percent between 2021 and 2022, according to the new report.

But public health departments are not as well connected to straight women as they are to community organizations that help gay and bisexual men with HIV and STI prevention.

“There is a lack of awareness among women of childbearing age that syphilis still exists and that it can affect them and what the consequences could be for the fetus,” Dr. Bagdasarian said.

Pregnant women may not have symptoms or know they need testing or treatment.

The CDC recommends testing for syphilis at the first prenatal visit or as soon as the pregnancy is identified. For women at high risk of infection due to where they live, substance use, or sexual behavior, the CDC suggests getting two more tests: at 28 weeks gestation and at delivery.

Many states go further and require all pregnant women to be tested for the infection at all three time points. This is partly because women who test negative early in pregnancy can contract syphilis later.

They may even be “at higher risk because they are no longer using protection like condoms,” said Dr. Melanie Taylor, a medical epidemiologist with the Maricopa County Department of Public Health in Arizona.

Prevention efforts must go beyond prenatal care for pregnant women and reach their partners as well as other heterosexual men and women, Dr. Taylor said.

Maricopa County has some of the highest rates of congenital syphilis in the country. Nearly half of the county’s women who had babies with syphilis did not receive prenatal care in 2022. Drug use, particularly fentanyl and methamphetamine, and recent incarceration are big contributors, Dr. Taylor said.

The county is working with hospitals and community organizations to reach women who use drugs, were recently incarcerated, have unstable housing, or are otherwise at high risk for syphilis.

The public STI clinic, which sees up to 35,000 patients a year, charges a flat fee of $20 to test and treat patients and their partners, and waives the fee if cost is a barrier.

Two positive tests are usually needed to confirm a syphilis diagnosis, but the CDC recommends that providers treat women who may not return after a single positive test.

Early cases of syphilis in a pregnant woman can be treated with a single injection of an antibiotic called benzathine penicillin G, marketed as Bicillin by Pfizer. In June, Pfizer warned The Food and Drug Administration said bicillin was in short supply, in part because of the sharp increase in demand for syphilis treatment.

The CDC has asked health care providers to prioritize the use of bicillin in 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 treatment numbers for this year may be worse.

More treatment options, particularly those that are affordable, would make things easier, as would vaccines and better testing. “Syphilis testing technology really hasn’t changed much in many, many, many decades,” Dr. Bachmann said.

“There is a lot of space to work here,” he stated. “It’s obvious we have a broken system.”

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