Congenital syphilis cases in the U.S. have skyrocketed, CDC says

The number of babies born with congenital syphilis in the United States has soared over the last decade, leading to an increase in stillbirths, infant deaths, and life-altering birth defects, the Centers for Disease Control and Prevention reported Tuesday.

The number of cases of congenital syphilis in 2022 was more than 10 times the number recorded in 2012, the agency said, noting that most of the 3,761 cases reported in 2022 could have been averted, if the babies’ mothers had been adequately tested and treated.

“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” said Debra Houry, the CDC’s chief medical officer. “New actions are needed to prevent more family tragedies. We’re calling on health care providers, public health systems, and communities to take additional steps to connect mothers and babies with the care they need.”

The problem is most acute among certain racial and ethnic groups, the CDC reported, saying babies born to Black, Hispanic, American Indian, and Alaska Native mothers were up to eight times more likely to have congenital syphilis in 2021 than babies born to white mothers.

The increase in congenital syphilis is linked to an overall rise in the rate of the sexually transmitted infection among women of reproductive ages.

It comes at a time when the rates of babies born with HIV or hepatitis B have actually declined, because of preventive procedures that have become part of standard care of pregnant people, said Robert McDonald, lead author of the report and a medical officer in the CDC’s division of sexually transmitted diseases prevention. But whereas pregnant people are routinely tested for HIV and hepatitis B, the same is not happening yet with syphilis, he said.

The CDC is hoping to change that, urging a range of health care providers to take whatever opportunities present themselves to test pregnant people for syphilis. Rapid tests, which produce immediate results, should be used to identify pregnant people who are infected so they can be treated on the spot, to prevent what is a too-common problem — people who cannot be contacted or won’t return for treatment when the results of a more traditional blood test come in.

There is a single recommended treatment for syphilis during pregnancy, a drug called benzathine penicillin G. If a syphilis infection is detected early, the treatment can be given in a single injection; later-stage infections require three injections given seven to nine days apart, a challenging regimen, especially for people who may not be getting regular prenatal care. The drug has been reported to cure the infection in 98% of cases, but there is a current shortage, leading the CDC to urge health providers and public health departments to prioritize its use for treatment of syphilis in pregnancy.

The CDC study found that of the congenital syphilis cases reported in 2022, 231 of the pregnancies resulted in stillbirths and 51 in infant deaths. If they are not adequately treated, babies born with congenital syphilis who survive can develop blindness, deafness, developmental delays, and skeletal abnormalities.

The CDC recommends that pregnant people be screened for syphilis on their first prenatal health visit, or as soon as pregnancy is diagnosed. Testing should be repeated at 28 weeks gestation and at birth for pregnant people who live in communities with high rates of syphilis and are at high risk of re-infection during pregnancy because of substance use or having a new sexual partner. In 2021, 38% of U.S. counties — home to 70% of the U.S. population — had syphilis rates that put them in the high-risk category.

“The key point is if somebody is treated and they are at high risk for reinfection, then you want to make sure that they are rescreened and treated if appropriate,” McDonald said.

While routine screening could lower the number of babies born with congenital syphilis, it is a task that is easier said than done — as other statistics in the newly released report reveal.

Nearly 40% of the babies born with congenital syphilis in 2022 were born to pregnant people who received no perinatal care, suggesting that simply asking obstetricians and gynecologists to add syphilis screening to the list of things they test for during pregnancy will not alone solve this problem. And a substantial number of the pregnant people with affected babies either had inadequate treatment or no documented treatment for their infections, even after testing positive for syphilis. McDonald said without the use of rapid tests, the opportunity to cure syphilis before the fetus is harmed can be lost in many cases.

“The less time that a fetus is exposed to syphilis, the better. But what we’ve found is that as long as you treat prior to 30 days before birth, that’s the ideal situation for preventing the negative outcomes of congenital syphilis,” he said.

The public health community will need to be creative about delivering the needed care to reduce the rate of congenital syphilis, he suggested, noting that for some infected pregnant people, their only intersection with health care may be emergency departments, jail intake, syringe service programs, or community-based maternal and child health programs. If that’s the case “then you really need to start thinking about screening for syphilis in those locations,” McDonald said.

“Ideally, we want everyone to be getting their full prenatal care,” he said. “But if someone is not receiving their full prenatal care, we want to make sure they’re able to be screened and treated for syphilis to prevent congenital syphilis outcomes.”