• Posted September 16, 2021

Why Are More U.S. Babies Being Born With Syphilis?

The number of U.S. infants born with syphilis is climbing at an alarming pace, reaching a high not seen since the 1990s, according to new government figures.

Newborn syphilis, a potentially fatal condition, was at one time nearly eliminated in the United States. But the disease has seen a resurgence in recent years -- and 2020 was no exception, say researchers with the U.S. Centers for Disease Control and Prevention.

So far, there have been more than 2,000 known cases of newborn syphilis among U.S. infants born in 2020. That's up from 2019, and it continues a steep upward trend that began several years ago.

"It's the highest number we've seen in 25 years," said Virginia Bowen, lead author of a CDC report published Sept. 16 in the New England Journal of Medicine.

Syphilis is a sexually transmitted bacterial infection that, left untreated, can cause serious health problems. One consequence is congenital syphilis, which is passed from mother to baby during pregnancy.

Congenital syphilis can have "devastating" effects, Bowen said -- including miscarriage, stillbirth, newborn death and, in infants, complications such as deformed bones, blindness and hearing loss.

Congenital syphilis is on the rise because of a broader problem: More Americans than ever have sexually transmitted infections, including gonorrhea, chlamydia and syphilis.

"This is really a direct reflection of what we're seeing among women and their male partners," Bowen said.

Less than 20 years ago, syphilis was virtually non-existent in the United States. In the intervening years, however, the disease has come roaring back. In 2019, almost 130,000 syphilis cases were reported nationwide, according to the CDC -- a 74% increase from 2015.

Why? There are certain factors that put people at increased risk of syphilis, Bowen said.

Drug abuse is one such factor, and the nation's opioid epidemic has been cited as a reason for the syphilis surge. A 2019 CDC study found that in recent years, a growing percentage of women and heterosexual men with syphilis reported using methamphetamine, heroin or other injection drugs.

At the same time, public health resources aimed at STD prevention, screening and treatment have dwindled, according to David Harvey, executive director of the National Coalition of STD Directors.

The organization, which represents public health department STD directors, said that since 2003, the CDC's division on STD prevention has been funded at a 40% reduction.

"The one federal agency focused on STD prevention has been starved of funding for the past 20 years," Harvey said.

The fortunate thing about syphilis is that it's easily cured with antibiotic injections, even as little as one. That's why it once was virtually vanquished.

However, that also means most Americans see syphilis as a disease of the past. Even among health care providers, many may not have it on their radar, Harvey and Bowen said.

To help prevent congenital syphilis, the CDC says all pregnant women should be screened for the disease at their first prenatal visit. Women at increased risk -- because of high syphilis rates in their local area, for instance -- should be screened again in the third trimester and at delivery.

Even when a pregnant woman has the infection, antibiotic treatment can prevent her from passing it on to her baby.

Yet, other CDC research has found, congenital syphilis still occurs, in part, because some women lack timely prenatal care. In other cases, they are in prenatal care, but screening or treatment are not done on time.

"That's a failure of the system," Harvey said.

Bowen agreed. "We don't need to have any congenital syphilis cases in the U.S.," she said.

Yet as of July 29, the CDC had received 2,022 reports of congenital syphilis among U.S. infants born in 2020. That number already surpasses the 1,870 cases reported for 2019, and will likely be higher once the reporting period ends in October, the agency reported.

While prenatal care is vital to battling newborn syphilis, Bowen said, the first line of defense is syphilis prevention in adults.

She encouraged people to talk with their health care provider about prevention and testing. "Don't be afraid to ask frank questions," Bowen said. "This is preventable and treatable."

Harvey made similar points. "Know your risk factors for sexually transmitted infections," he said. "Get tested regularly at a local clinic or your doctor's office, and use barrier protection, including condoms."

More information

The U.S. Centers for Disease Control and Prevention has more on congenital syphilis.

SOURCES: Virginia B. Bowen, PhD, MHS, Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta; David C. Harvey, MSW, executive director, National Coalition of STD Directors, Washington, D.C.; New England Journal of Medicine, Sept. 16, 2021