Despite being a completely preventable disease, cases of congenital syphilis rose 261% between 2013 and 2018.

By Claire Gillespie
July 08, 2020
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After years of decline, rates of congenital syphilis are once again on the rise in the US. According to an analysis published by the Centers for Disease Control and Prevention (CDC) on June 5, cases of congenital syphilis—or a syphilis infection passed from mother to baby during pregnancy—rose 261% from 2013-2018, from 362 cases to 1,306 cases. Of those 1,306 cases in 2018, the CDC reported 94 resulted in stillbirths or early infant deaths. 

“This is the highest number of congenital syphilis cases reported in the US since 1995,” Anne Kimball, MD, MPH, who works in the CDC's Division of Sexually Transmitted Disease Prevention, tells Health. “The rise in congenital syphilis parallels an increase in syphilis among women overall, so the increase is largely because more women of reproductive age (15-44) are getting syphilis. In fact, the US rate of primary and secondary syphilis has increased almost every year for nearly 20 years.”

The rise in cases, per the CDC, stems form "missed opportunities for congenital syphilis prevention" on a national level. That includes inadequate maternal treatment despite a timely diagnosis of syphilis in pregnant women in 30.7% of cases, and a lack of timely prenatal care in 28.2% of cases. For the sake of the study, the CDC defined adequate maternal treatment as completion of a penicillin-based regimen recommended for the mother’s stage of syphilis initiated at least 30 days before delivery. Timely prenatal care was defined as a regimen that took place at least 30 days before delivery, as well.

The missed opportunities for care and prevention also varied by geographic location, as well as race and ethnicity—both of which may be related to larger social issues and regional health disparities. In the South, for example, a lack of adequate treatment was the most common missed opportunity, with 34.3% of women not receiving proper treatment; while in the West, a lack of timely care (41.1%) was a larger contributing factor. Southern white women, too, were more likely to have less timely care (31.6%), but Black and Hispanic mothers suffered most from inadequate treatment (37.0%). The reasons behind those differences, however, weren’t explored, Dr. Kimball says, but she adds that understanding them can help state and local health departments tailor prevention solutions to the needs of their community and the people they serve. 

The increase in congenital syphilis cases has led to health care providers to call for more adequate maternal treatment, including syphilis prevention in women and their sex partners, and timely identification and treatment of syphilis in pregnant women. Because knowledge is also important in preventing disease, here's what you need to know about congenital syphilis, including symptoms associated with the disease and possible treatment and prevention options.

What is congenital syphilis?

Congenital syphilis is a disease that occurs in an infant or fetus when a mother with untreated (or inadequately treated) syphilis passes the sexually-transmitted infection (STI) on to her baby. “Congenital syphilis is caused by undiagnosed syphilis or under-treated syphilis—i.e. where the infection is treated late or not treated adequately,” Shieva Ghofrany, MD, a partner at Coastal Obstetrics & Gynecology in Stamford, Connecticut, tells Health. The mother can pass Treponema pallidum, the bacterium that causes syphilis, to her child through the placenta. 

The CDC details the major health impacts congenital syphilis can have on an infant or fetus, which can depend on how long the mother had syphilis, or if (or when) she was eventually treated for the infection. Congenital syphilis can cause miscarriage, stillbirth, prematurity, or low birth weight in a fetus, and up to 40% of babies born with congenital syphilis may be stillborn or will die as a newborn.

In babies born with congenital syphilis, the health effects include blindness, hearing loss, deformed bones, and cognitive delays, Dr. Kimball says. Other complications or symptoms of early congenital syphilis, per the National Organization for Rare Disorders (NORD) range from fever and jaundice (yellow coloring of the skin) to low birth weight.

Past that, some cases (known as late congenital syphilis) aren’t detected until the child is age 5 or older. In rare cases, symptoms aren’t diagnosed until adulthood. Bone pain, retinitis pigmentosa (a serious eye disease), a high arched palate, and fissuring around the mouth and anus are all characteristics of late congenital syphilis. 

Is congenital syphilis treatable or preventable?

Congenital syphilis is completely preventable, provided the mom has access to prenatal care, syphilis testing, and treatment. The CDC recommends that all women be tested for syphilis during their first prenatal visit. Additionally, it recommends that women living in areas with a high burden of syphilis—regardless of their individual risk factors—as well as women with individual risk factors that place them at higher risk of acquiring syphilis should be re-tested at 28 weeks and again at delivery.

“If a pregnant woman has a known syphilis-positive partner, she can prevent syphilis by using condoms or dental dams,” Dr. Ghofrany says. And if syphilis is diagnosed during pregnancy, it’s crucial that the right treatment—via antibiotics, according to the CDC's 2015 Sexually Transmitted Diseases Treatment Guidelines—is provided. If a pregnant woman is diagnosed with syphilis, she should be treated as soon as possible with a penicillin-based regimen that is both appropriate for the mother’s stage of syphilis and initiated 30 or more days before delivery. For women with late or unknown duration of syphilis, the required treatment for syphilis is 3 shots of penicillin—each spaced apart by 7 days.”

As for babies born with congenital syphilis, the CDC says it's important to treat them right away, so more serious health problems don't develop. "Depending on the results of your baby’s medical evaluation, he/she may need antibiotics in a hospital for 10 days," the CDC says. In some cases, only one antibiotic injection is necessary, though babies should continue to get follow-up care to make sure the treatment worked.

Overall, the CDC’s recent analysis of congenital syphilis rates makes one thing very clear, Dr. Kimball says. “As a health care system, we are missing opportunities to screen and treat women for syphilis during prenatal care,” she says. “We also need to improve access to prenatal care and family planning for all women.”

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