Tl;dr: Congenital syphilis is a disease that occurs when a pregnant person passes the infection on to their baby during pregnancy and can be very serious. Rates of congenital syphilis have significantly increased in the last decade. Congenital syphilis can be prevented by finding and treating syphilis in pregnancy. Unfortunately, lack of access to pregnancy care, testing, and treatment are major reasons why we are seeing more and more babies born with syphilis.
Babies born with syphilis are at high risk of serious and life-threatening illness. Congenital syphilis can cause miscarriage, stillbirth, prematurity, and infant death. Babies can also develop deformed bones, rashes, low blood count, vision loss, and brain and nerve problems. Finding and treating syphilis during pregnancy is an important way to prevent the transmission of syphilis to the baby during pregnancy.
The United States has seen a huge increase in congenital syphilis cases over the last 10 years. In 2012, there were just 335 reported cases of congenital syphilis. In 2022, there were over 3,700 cases reported. Of these, nearly 300 babies died or were stillborn. About 9 in 10 of these cases could have been prevented with prompt testing and treatment during pregnancy. More than half of reported cases were born to people who tested positive for syphilis in pregnancy but did not receive proper treatment.
Why aren’t people getting tested and treated?
There are lots of factors impacting folks’ ability to get tested and treated during pregnancy. For example, people from racial and ethnic minorities were at increased risk of newborn syphilis due to systemic racism and limited healthcare access.
People who have substance use disorders, lower incomes, less education, or are incarcerated are also less likely to get treated if they are found to have syphilis. This can come from systemic barriers to treatment, like lack of access to transportation, insurance coverage, financial concerns, or inability to miss work for medical care. This can also reflect prejudice in healthcare systems and by healthcare professionals.
A shortage of long-acting penicillin G, the antibiotic used to treat syphilis, complicates things. It is the only recommended treatment in pregnancy. On top of the shortage, treatment can require multiple shots each given a week apart. This requires added time and connection to healthcare systems that many folks can’t swing.
What can be done to reduce the rates of congenital syphilis?
➡️ Get tested! The CDC recommends testing for syphilis during the first prenatal care visit, and at 28 weeks of the pregnancy and during delivery for high-risk individuals. The CDC also recommends syphilis screening for all sexually active persons in communities with high rates of syphilis or people whose sexual practices increase their risk for sexually transmitted infections.
➡️ Practice safe sex. Using condoms can reduce the risk of syphilis transmission during sex.
➡️ If you test positive, get treatment right away. Talk with your primary care clinician about treatment plans.
➡️ Manufacturers are working to increase the supply of critical antibiotics and are hopeful this will improve next year.
➡️ Healthcare systems and communities need to reduce barriers for pregnant people, particularly for marginalized and underserved populations.
Stay safe. Stay well.
Those Nerdy Girls
Contemporary OB/GYN – MMWR: Congenital syphilis cases have surged in the United States