While perinatal infections like HIV and hepatitis B are declining in the United States, there has been a substantial increase in cases of congenital syphilis. A new study from the Centers for Disease Control and Prevention revealed that between 2012 to 2021, reported cases of congenital syphilis rose by 755%, with the number reaching 2,865 in 2021.
Congenital syphilis can have devastating consequences, including stillbirth, miscarriage, neonatal death, and long-term health complications for surviving infants. Thankfully, it is a preventable condition through early testing and adequate treatment during pregnancy.
Interestingly, the rise in congenital syphilis cases mirrors the increasing rates of primary and secondary syphilis among women of reproductive age. These rates have increased by 676% from 2012 to 2021.
To reduce transmission, the CDC recommends screening for syphilis during the early stages of pregnancy. If access to prenatal care is limited, screening and treatment should be initiated as soon as you learn you’re pregnant.
Additionally, screening at 28 weeks gestation and delivery is recommended for those living in high-risk areas or who are at risk of acquiring syphilis during pregnancy.
Early screening and appropriate treatment have been proven to prevent syphilis-related complications. Identifying missed opportunities for prevention and treatment is crucial in understanding the factors driving the current surge in congenital syphilis and guiding public health interventions.
In 2022, a total of 3,761 congenital syphilis cases were reported, marking a 31.7% increase from the previous year. This corresponds to a 17.2% increase in primary and secondary syphilis rates among females aged 15-44.
The only recommended treatment for syphilis during pregnancy is benzathine penicillin G, which must be administered by a trained professional as an injection in either a single dose or as three doses spaced 7-9 days apart, depending on the stage of infection. This treatment has a reported success rate of up to 98% in preventing congenital syphilis.
“The congenital syphilis epidemic is an unacceptable American crisis. 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,” said Jonathan Mermin, M.D., M.P.H., Director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
With the rates of congenital syphilis in the United States now at the highest level in at least 30 years, the barriers to prevention need to be addressed. They are, however, multi-faceted, and involve patient-level factors such as substance use and insurance status, as well as system-level factors like structural inequities, limited access to healthcare, and medication shortages. By addressing these barriers and improving timely testing and appropriate treatment, both locally and nationally, the CDC believes the congenital syphilis epidemic in the United States can be controlled.
In addition to raising awareness of the issue and calling for a coordinated approach to address the problem, National Association of County and City Health Officials (NACCHO) has worked to bring awareness to the impact of drug shortages on treating syphilis in pregnant people. Last month, NACCHO sent a letter to the White House Drug Shortage Taskforce urging them to prioritize efforts related to the shortage of penicillin G benzathine. Without intervention for greater pharmaceutical production, the situation will worsen.
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VIA CDC – McDonald R, O’Callaghan K, Torrone E, et al. Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022. MMWR Morb Mortal Wkly Rep. ePub: 7 November 2023. DOI: http://dx.doi.org/10.15585/mmwr.mm7246e1.
