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Congenital syphilis —an ancient scourge — claimed the lives of eight NC babies last year

Photo illustration by Jennifer Fernandez
NC Health News

Last year, congenital syphilis led to six stillbirths in North Carolina and two neonatal deaths, according to preliminary data.

Syphilis, a bacterial infection transmitted by sexual contact, is typically seen more often in men. In recent years, however, it has been on the rise in women — and therefore, babies.

“It's changed the landscape of syphilis in general, but particularly around syphilis in infants,” said Victoria Mobley, HIV/STI medical director for the North Carolina Department of Health and Human Services’ Division of Public Health.

A newborn may not show any signs of syphilis but can develop serious problems within a few weeks — or even years — if not treated. Likely health issues include developmental delays, hearing loss, vision problems, bone abnormalities and neurological issues.

North Carolina health officials, alarmed by the growing number of congenital syphilis cases, are working on multiple fronts to try to reverse that trend, including a new website.

N.C. Department of Health and Human Services has a website with information on syphilis, including a section on congenital syphilis. It is part of efforts to educate residents about the sexually transmitted infection because of the growth of cases in women and newborns.
N.C. Department of Health and Human Services has a website with information on syphilis, including a section on congenital syphilis. It is part of efforts to educate residents about the sexually transmitted infection because of the growth of cases in women and newborns.

Rising numbers

Once a relatively common disease, syphilis all but disappeared after the introduction of penicillin as a cure in 1940.

In 2000, incidence of the disease reached a historic low in the U.S., and a little more than a decade ago, North Carolina recorded only one case of congenital syphilis. By 2022, that had jumped to 53 congenital cases and no deaths.

Last year, preliminary data shows, there were at least 71 cases, including six stillbirths and two neonatal deaths, Mobley told members of the state Child Fatality Task Force last week. A neonatal death is defined as a child born alive who dies within 28 days.

The data is preliminary because the state is still waiting on information about babies born at the end of last year, she said.

If the disease is present in a pregnant person, syphilis can lead to premature birth, low birth weight, stillbirth or a newborn’s death shortly after birth.

Syphilis is easily transmittable. It presents initially as sores in the genital area and later as a rough, red rash, according to the Centers for Disease Control and Prevention. Later stages can have no symptoms, but left untreated, syphilis can cause damage to the brain, heart and other organs.

The CDC said in November that the increase in syphilis constitutes a national epidemic; they announced that more than 3,700 U.S. babies were born with syphilis in 2022 — more than 10 times the number from a decade earlier.

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

CDC asked healthcare providers to make some changes to help catch cases earlier or prevent them. Suggestions range from starting syphilis treatment earlier after a positive rapid test to screening sexually active women and their partners in counties with high syphilis rates.

There’s also a federal task force focused on reducing rates.

Contributing factors

As part of addressing the crisis, North Carolina health officials needed to find out what was contributing to the rise in cases in the state.

Interviews with some of the mothers with congenital syphilis in 2022 showed three areas of concern, Mobley told Child Fatality Task Force members last week.

The mothers reported they:

  • Had no prenatal care or care that was delayed.
  • Had not been screened for syphilis during pregnancy as prescribed by state health rules.
  • Had experienced delays in treatment once diagnosed.

More than half of the congenital syphilis mothers had no documented prenatal care at the time they delivered, Mobley said.
Of the women who did have prenatal care, only 41 percent received the appropriate screenings, she said. State law requires providers to conduct a syphilis test for anyone who is pregnant at their first prenatal visit, again between 28 to 30 weeks of pregnancy and when they deliver the baby.

For more than half of the mothers, treatment began within a week of their diagnosis. About a quarter of the mothers didn’t start treatment for more than two weeks.

“Of course, the faster you initiate treatment, the more likely you are to prevent the infection or, if not prevent, eradicate the infection in the unborn infant,” Mobley said.

Those interviews helped inform some of the state’s approach to the crisis.

Effects of congenital syphilis

Congenital syphilis is when the highly contagious bacterial infection passes from the mother to the fetus in the womb or to a newborn at birth.

It can lead to:

  • Miscarriage
  • Stillbirth
  • Premature birth
  • Low birth weight
  • Death shortly after birth

Babies born infected with syphilis can have:

  • Skin rashes
  • Jaundice (yellowing of the skin or eyes)
  • Severe anemia (low red blood cell count)
  • Deformed bones
  • Enlarged liver and spleen
  • Meningitis (infection/inflammation of tissue surrounding spinal cord and brain)
  • Brain and nerve problems (including blindness or deafness)

Source: Centers for Disease Control and Prevention

What is NC doing?

Last October, North Carolina health leaders met with other health officials and insurers from across the Southeast to talk about collaborating on ways to bring down the number of congenital syphilis cases.

They agreed to a set of standards:

  • Women should be tested for syphilis at the prenatal visit, between 28 and 32 weeks and at delivery. 
  • Newborns should not be discharged from the hospital until the mother’s delivery syphilis test results are known. 

In December, North Carolina launched a media campaign focused on the importance of syphilis testing for anyone who is sexually active. That campaign will expand over the next three months, Mobley said.
The state also created a website with information on syphilis and resources such as testing sites.

Other efforts include reaching out to healthcare providers to encourage increased screening of pregnant women in all settings and increasing access to rapid tests for syphilis and HIV.

Mobley said the state is also working on improving reimbursement rates for Bicillin, the penicillin product that is commonly used to treat syphilis, to encourage more sites to keep it in stock.

“Congenital syphilis is a completely preventable infection with devastating consequences,” said Shannon Dowler, chief medical officer for NC Medicaid, in a statement last month announcing the collaboration efforts. “The time is right to attack this problem differently.”

More information on syphilis can be found on the state's new website here. Find free testing sites at gettested.cdc.gov.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.

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