Newborn syphilis cases in US up by 261% due to serious gaps in testing and treatment: CDC report
The most commonly missed opportunity for preventing congenital syphilis was a lack of adequate maternal treatment, likely driven by the high numbers of cases in the South, where this was most prevalent
An estimated one in two newborn syphilis cases occur in the US due to gaps in testing and treatment during prenatal care, according to a new report by the US Centers for Disease Control and Prevention (CDC). The number of reported congenital syphilis cases in the US has increased by 261% during 2013-2018 from 362 to 1,306. This suggests a public health failure in the US as timely identification and treatment of maternal syphilis during pregnancy can prevent congenital syphilis.
Among reported congenital syphilis cases during 2018, a total of 94 resulted in stillbirths or early infant deaths. “The number of congenital syphilis cases in the US increased 261% during 2013-18. Rates of congenital syphilis mirror rates of primary and secondary syphilis among women of reproductive age, which approximately doubled during 2014-18,” say researchers in their analysis.
Congenital syphilis is an infection (with Treponema pallidum) in an infant or fetus, acquired during pregnancy from a mother with untreated or inadequately treated syphilis. Congenital syphilis can cause miscarriage, stillbirth, or early infant death, and infected infants can experience lifelong physical and neurologic problems. “Congenital syphilis is a condition affecting stillbirths and infants born to mothers with untreated or inadequately treated syphilis regardless of signs in the infant, or a condition affecting an infant with clinical evidence of congenital syphilis,” says the report.
The researchers found that nationally, the most commonly missed prevention opportunities were a lack of adequate maternal treatment despite the timely diagnosis of syphilis (30.7%), likely driven by the high numbers of cases in the South, where this missed opportunity was most prevalent. This is followed closely by a lack of timely prenatal care (28.2%), with variation by geographic region.
The national pattern was reflected in the South: lack of adequate treatment was 34.3% while lack of prenatal care was 19.9%. In the West, however, the most commonly missed opportunity was a lack of timely prenatal care (41.1%), followed by a lack of adequate maternal treatment despite a timely diagnosis (28.6%). “In the Northeast, the most commonly missed opportunity was late identification of seroconversion during pregnancy (39.6%),” say researchers.
Racial or ethnic disparities existed within the highest morbidity regions. In the South, the most commonly missed prevention opportunity among white mothers of infants with congenital syphilis was lack of timely prenatal care (31.6%), whereas, among black and Hispanic mothers, lack of adequate maternal treatment (37.0%) was the most common. “In the West, racial/ethnic differences were less pronounced: regardless of race/ethnicity, over 41% of mothers of infants with congenital syphilis lacked timely prenatal care, and over 29% lacked adequate treatment despite receipt of a timely syphilis diagnosis,” the findings state.
The detailed analysis further shows that among 1,306 congenital syphilis cases reported in the US during 2018, 685 (52.5%) occurred in the South, 465 (35.6%) in the West, 103 (7.9%) in the Midwest, and 53 (4.1%) in the Northeast Census regions. Nationally, 510 (39.1%) mothers of infants with congenital syphilis were non-Hispanic black (black), 411 (31.5%) were Hispanic, 286 (21.9%) were non-Hispanic white (white), and 99 (7.6%) were of another race/ ethnicity. “Approximately half of the mothers of infants with congenital syphilis in the Midwest (54.4%) and Northeast (56.6%) had early stages of syphilis, compared with those in the South (36.6%) and the West (36.8%). The percentage of congenital syphilis cases that were live-born and symptomatic (33.2% nationally) or stillborn (6.0% nationally) also varied by region,” it says.
The researchers explain that regional, clinical and demographic differences in mothers of infants with congenital syphilis indicate that different populations are at increased risk and need different interventions. They emphasize that interventions are needed for identifying pregnant women with syphilis outside of prenatal care and for reducing barriers to prenatal care for all women.
The CDC calls for timely follow-up of positive syphilis test results for pregnant women. The agency recommends syphilis screening for all pregnant women at the first prenatal visit with a repeat screening at 28 weeks and at delivery for women in high prevalence areas or who are at increased risk for acquisition to reduce congenital syphilis and its associated deaths. “Halting continued increases in congenital syphilis requires collaboration between public health and healthcare sectors, understanding the missed prevention opportunities, and implementing tailored interventions based on local experience,” says the research team.