NACCHO Requests Response for the Alarming Rates of Infant Syphilis

In a recent report published on November 7, the Centers for Disease Control and Prevention (CDC) urged immediate action to halt the rise in instances of neonatal syphilis.

According to the new statistics published in CDC Vital Signs, there was a notable increase in congenital syphilis cases in 2022, which impacted communities throughout the country and disproportionately affected the vulnerable population.

In 2022, there were approximately 3,700 newborns born with syphilis, 10 times more than in the previous 10 years. Nearly nine out of 10 cases in 2022 may have been avoided with prompt detection and treatment during pregnancy.

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Rebekah Horowitz, the Director of STI Programs at the National Association of County and City Health Officials (NACCHO,) shares with Healthnews that the biggest priority is for Congress to fund the response to syphilis like the emergency that it is.

The public health infrastructure has been decimated with funding increases to address STIs being few and far between, outside of COVID funding much of which was later rescinded in the budget deal earlier this year.

Without funding, health departments do not have the staff to do jobs such as disease investigation, which allows for following up with cases of syphilis to confirm that they were properly treated and notifying partners of identified cases of syphilis of their potential exposure, and most importantly, supporting pregnant people to receive prenatal care, confirm they have received their needed syphilis tests throughout their pregnancy, and ultimately, confirming the treatment of any syphilis cases.

- Horowitz

Additionally, Horowitz says that in the CDC release, it was made clear that providers such as OB-GYNs cannot be asked to tackle the issue of rising syphilis and other STI rates, and that people need an all-hands-on-deck approach.

Public health departments are the entities that will reach out and educate providers in many settings where STIs have not previously been addressed, such as in jails, pharmacies, urgent care, and emergency rooms, on how to do testing and treatment without additional funding, that is not something that they will have the capacity to do.

Finally, when individuals come in contact with healthcare and public health, they should discuss whether they need syphilis testing.

What is syphilis?

Syphilis is a bacterial infection that is most often spread through sexual contact. It can also be spread from a pregnant person to their fetus during pregnancy. In many people and cases, it has minimal symptoms, which is what makes it so hard to detect without regular testing.

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When there are symptoms, they usually appear within 21 days of exposure and appear as a small painless ulcer at the site where the syphilis entered the body, including the penis, vagina, rectum, or the mouth.

Because of this appearance of symptoms, individuals, and sometimes even providers, may not recognize the symptoms as syphilis.

The sore usually lasts three to six weeks and will heal regardless of treatment. If the syphilis infection is not treated, it can progress to secondary syphilis and then to tertiary. Latent syphilis is a period where there are no visible signs or symptoms of the infection.

In addition to the sores mentioned above, syphilis can cause damage to the heart, brain, or other organs and can become life-threatening.

Syphilis may even invade the nervous system, visual system, and auditory or vestibular system. Any of these will have their own sets of symptoms and damage that they can cause.

Depending on how long a pregnant person has had syphilis, they may be at high risk of having a stillbirth or the baby may die shortly after birth. Untreated syphilis in pregnant people results in infant death in up to 40% of cases.

Additionally, a baby born alive with syphilis may not have any signs or symptoms of disease but without immediate treatment, serious problems may develop including developmental delays, seizures, or death.

The new CDC data highlight what our local health departments across the country are seeing firsthand—syphilis cases are on the rise with dire consequences, particularly for those who are pregnant and their newborns.

- Lori Tremmel Freeman, the Chief Executive Officer at NACCHO.

The most susceptible are those who are pregnant or who reside in high-risk areas; according to the CDC research, these groups affect more than 70% of Americans in 38% of U.S. counties.

Furthermore, there is a markedly increased risk of neonatal syphilis among children born to women who identify as Black, Hispanic, American Indian, or Alaska Native.

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Discrepancies in syphilis prevalence by race and ethnicity are caused by systematic racism in medical treatment, variations in sexual networks, and access to healthcare rather than sexual practices. The stigma and prejudices associated with screening based on individual risk factors may be lessened by screening based on regional risk.

The grim new CDC report on cases of syphilis in newborns prompted NACCHO to call for a coordinated, multisector response, highlighting the need for quick testing and treatment.

Precautions against syphilis

Horowitz emphasizes that testing is key to precaution. If you or your partner are pregnant, make sure that you are being tested for syphilis at your first visit and a minimum, in the third trimester.

If you or your partner is not pregnant and does not want to become pregnant in the foreseeable future, discussing the options to avoid pregnancy is a great way to avoid syphilis as a pregnant person and therefore a possible case of congenital syphilis.

NACCHO has worked to increase awareness of the impact of medicine shortages on treating syphilis in pregnant women in addition to asking for a coordinated approach to solve the problem.

The White House Drug Shortage Taskforce received a letter from NACCHO in October pleading with them to give the scarcity of penicillin G benzathine (Bicillin L-A), the only therapy for syphilis that is available to pregnant patients, a top priority. NACCHO says the current situation will deteriorate without action to increase pharmaceutical output.

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