Congenital syphilis on the rise

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For a decade, the number of babies born with syphilis in the United States has been increasing, undeterred. Data released this month by the Centers for Disease Control and Prevention shows just how serious the outbreak has become.

In 2012, 332 babies were born infected with the disease. By 2021, that number had nearly sevenfold, to at least 2,268, according to preliminary estimates. And 166 of those babies died.

About 7% of babies diagnosed with syphilis in recent years have died; thousands more people born with the disease faced problems such as brain and bone malformations, blindness and organ damage.

For public health officials, the situation is all the more heartbreaking as congenital syphilis rates hit near-historic modern lows from 2000 to 2012 amid ambitious prevention and education efforts. In 2020, following a severe erosion of funding and attention, the nationwide case rate was more than seven times higher than in 2012.

‘It’s an outrage’: Soaring congenital syphilis rates put babies at grave risk

“What’s really depressing is that we pretty much eradicated this thing by the year 2000,” said William Andrews, public information officer for the Oklahoma Sexual Health and Harm Reduction Service. . “Now he’s back with a vengeance. We’re really trying to get the message across that sexual health is health. It’s nothing to be ashamed of.”

Even as case numbers soar, the CDC’s budget for the prevention of sexually transmitted diseases — the main source of funding for most public health departments — has been largely stagnant for two decades, its purchasing power being even lower due to inflation.

A recent CDC report on STD trends provides official data on congenital syphilis cases for 2020, as well as preliminary case counts for 2021 that are expected to increase. CDC data shows that congenital syphilis rates in 2020 continued to climb in already overwhelmed states such as Texas, California and Nevada, and the disease is present in nearly every state in the country. All but three states — Maine, New Hampshire and Vermont — reported cases of congenital syphilis in 2020.

Perspective: Syphilis kills babies in the United States A reason? The CDC budget.

From 2011 to 2020, congenital syphilis resulted in 633 documented stillbirths and infant deaths, according to new CDC data.

Prevention of congenital syphilis – the term used when syphilis is transmitted to a fetus in utero – is medically extremely simple: if a pregnant person is diagnosed at least one month before delivery, a few injections of penicillin have an almost perfect effect. cure rate for parent and baby. But funding cuts and competing priorities in the country’s fragmented public health system have dramatically reduced access to these services.

The reasons why pregnant women with syphilis are not diagnosed or treated vary geographically, according to data collected by states and analyzed by the CDC.

Little or no prenatal care

In western states, the largest share of cases are in patients who received little or no prenatal care and who are not tested for syphilis before giving birth. Many have substance use disorders, primarily related to methamphetamines. “They felt a lot of judgment and stigma from the medical community,” said Stephanie Pierce, a maternal-fetal medicine specialist at the University of Oklahoma who runs a medical clinic for people with pregnancies. high risk.

In southern states, a CDC study of 2018 data found that the largest share of congenital syphilis cases were among women who had been tested and diagnosed but had not received treatment. That year, among black mothers who gave birth to babies with syphilis, 37% had not been adequately treated despite being diagnosed in a timely manner. Among white mothers, that number was 24%. Longstanding racism in medical care, poverty, transportation problems, poorly funded public health services and overcrowded clinics whose staff are too overworked to follow up on patients all contribute to the problem, health experts say. Infectious diseases.

Racism in care drives health disparities, doctors and other experts say as they push for change

Doctors are also noticing an increasing number of women treated for syphilis but reinfected during pregnancy. Amid rising cases and stagnating resources, some states have focused disease investigations on pregnant women of childbearing age; they can no longer prioritize the treatment of sexual partners who are also infected.

Eric McGrath, a pediatric infectious disease physician at Wayne State University School of Medicine in Detroit, said he’s seen several newborns in recent years whose mothers were treated for syphilis but then re-exposed during the pregnancy by partners who had not been treated.

Treating a newborn for syphilis is not trivial. Penicillin carries few risks, but giving it to a baby often involves a lumbar puncture and other painful procedures. And treatment usually means keeping the baby in hospital for 10 days, breaking an important time for family ties.

McGrath has seen a few babies in his career who weren’t diagnosed or treated at birth who later came to him with full-blown syphilis complications, including rashes all over their bodies and livers inflamed. It was a horrible experience that he does not want to repeat. The preferred course, he said, is to spare the baby the ordeal and treat the parents early in the pregnancy.

But in some places, providers don’t routinely test for syphilis. Although most states require testing at some point during pregnancy, as of last year only 14 required it for everyone during the third trimester. The CDC recommends third-trimester screening in areas with high rates of syphilis, a growing share of the United States.

STD rates remained high in the first year of the pandemic

After Arizona declared a statewide epidemic in 2018, state health officials wanted to know if widespread third-trimester testing could have prevented infections. Looking at 18 months of data, analysts found that nearly three-quarters of the more than 200 pregnant women diagnosed with syphilis in 2017 and the first half of 2018 received treatment. This left 57 babies born with syphilis, nine of whom died. Analysts estimated that a third of infections could have been prevented with testing in the third quarter.

Based on the numbers they saw over those 18 months, officials estimated that testing all women on Medicaid in the third trimester would cost the state $113,300 a year, and that treating all the syphilis cases that screening could catch could be done for just $113. Factoring in the costs of hospitalizing infected infants, officials concluded that the additional testing would save the state money.

And yet the money for prevention has been hard to come by. Adjusted for inflation, CDC funding for STD prevention has dropped 41% since 2003, according to an analysis by the National Coalition of STD Directors. That’s even when cases spiked, leaving public health departments struggling with more work and far less money.

Janine Waters, STD program manager for New Mexico, watched the outcome.

When Waters began her career more than 20 years ago, she and her colleagues tracked every reported case of chlamydia, gonorrhea and syphilis, not only making sure people got treatment, but also contacting their sexual partners, with the aim of stopping the spread of infection. In a 2019 interview with Kaiser Health News, she said her team members struggled to track syphilis on their own, even as they checked in with dreaded cases of congenital syphilis rising in Texas and Arizona. neighbors.

In 2020, New Mexico had the highest rate of congenital syphilis in the country.

The pandemic has exhausted the remaining resources. Half of health departments across the country have completely halted STD fieldwork, diverting resources to covid-19. In California, which for years has struggled with high rates of congenital syphilis, three-quarters of local health departments have sent more than half of their STD staff members to work on covid.

Experts: Massive push for coronavirus testing crippled screening, fight against STDs

As the pandemic wanes – at least in the short term – many public health departments are once again turning their attention to syphilis and other diseases. And they do it with reinforcements. Although the Biden administration’s proposed STD prevention budget for 2023 remains stable, the American Rescue Plan Act provided $200 million to help health departments strengthen contact tracing and surveillance for covid-19 and other infectious diseases. Many ministries direct this money to STDs.

The money is an infusion that public health officials say will make a difference. But adjusting for inflation, that essentially brings funding for STD prevention back to where it was in 2003, said Stephanie Arnold Pang of the National Coalition of STD Directors. And US bailout money does not cover some aspects of STD prevention, including clinical services.

The coalition wants to revive dedicated STD clinics, where people can go for tests and treatment at little or no cost. Proponents say it would fill a void that has plagued treatment efforts since the mass closure of public clinics following the 2008 recession.

Texas, which is battling its own widespread epidemic, will use its share of US bailout money to fill 94 new positions focused on various aspects of STD prevention. These hires will bolster a series of measures the state put in place before the pandemic, including an updated data system to track infections, review boards in major cities that look at what went wrong. worked for every case of congenital syphilis, and a requirement that providers test for syphilis in the third trimester of pregnancy. The suite of interventions appears to be working, but it could take a while before cases decline, said Amy Carter, the state’s congenital syphilis coordinator.

“Growth didn’t happen overnight,” Carter said. “So our prevention efforts won’t have a direct impact overnight either.”

This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides information on health issues to the nation.

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