• Posted September 21, 2023

In Mississippi, a Huge Jump in Cases of Babies Born With Syphilis

The United States is experiencing an alarming wave of congenital syphilis, and one southern state saw a 1,000% rise in babies born with the infection between 2016 and 2022.

The number of babies born with the infection in Mississippi rose from 10 in 2016 to 110 in 2022. Syphilis is a sexually transmitted bacterial infection. Congenital syphilis occurs when an infected mother passes the disease to her unborn infant.

"This sort of mirrors what we've seen in the country, but like a lot of things, because of our health disparities in Mississippi, adverse trends across the country tend to get concentrated in our state," said senior researcher Dr. Thomas Dobbs, dean of the School of Population Health at the University of Mississippi Medical Center in Jackson.

While researchers saw a disproportionate impact on minority populations, especially those who are covered by Medicaid, the impact goes well beyond those groups.

"We're also seeing it in the white population and also people with private insurance," Dobbs said. "So it's not limited only to certain subsets of our population."

A major driver of the syphilis epidemic is an underfunded public health system, Dobbs said.

"We have a third of those employees, compared to what we had just 20 years ago," he said. "This is a national phenomenon that tends to be worse in states like Mississippi."

He also blamed a shift in sexually transmitted disease (STD) detection from public health clinics and STD clinics to private practices that are not equipped to address treatment of intimate partners and ensure completion of that treatment.

In the 1990s, a campaign to fight syphilis and other sexually transmitted infections (STIs) nearly wiped out syphilis, according to Elizabeth Finley, a spokeswoman for the National Coalition of STD Directors, in Durham, N.C.

"They virtually eliminated congenital syphilis," Finley said. "They accomplished that goal because they undertook a concerted effort and they put funding behind it. But like many things with public health, once they achieved success, they pulled back funding and without a sustained investment, the rate started to go up again."

Dobbs said the COVID epidemic also drew already-limited public health funds away from STI prevention, testing and treatment.

The consequences of congenital syphilis can be devastating, he said.

"If you look at a baby who is infected with syphilis during pregnancy, there's about a 40% mortality rate," either in miscarriage, stillbirth or infant death, he explained.

A shot of penicillin, however, can cure both the mother and her unborn baby, Dobbs said.

"It's extremely important to find these moms so that we can treat them and then, you know, save the baby," he said. "It's horrible and unacceptable that we're missing moms that we can treat and save the baby."

Many babies who survive congenital syphilis have significant neurocognitive or other physical adverse effects, Dobbs said.

"After birth, there are treatments for the baby, but it's long and arduous," he said. "You have to have a hospital stay for an extra 10 days and get IV penicillin."

For the study, Dobbs and his colleagues analyzed data on infants diagnosed and hospitalized with congenital syphilis in Mississippi between 2016 and 2022.

Of the 367 infants with congenital syphilis, 340 were born in the hospital and 27 were admitted after being born elsewhere.

Overall, 93% were covered by Medicaid, and 58% were from rural areas.

Although the infected newborns were overwhelmingly African American (71%), the magnitude of increase was higher among white infants, according to the study.

Among Black babies, hospitalizations rose 1,029%, from seven infants in 2016 to 79 in 2022. The study authors noted that admissions among white infants skyrocketed 2,600%, from 1 in 2016 to 27 last year.

The researchers also found that babies with congenital syphilis were more likely to have mothers who used illegal drugs. They were also more apt to be born prematurely and have low birth weight.

Infants with congenital syphilis also had longer hospital stays than infants without the disease (15 days versus 4 days) and higher hospital bills ($57,000 versus $14,000), the investigators found.

"Part of solving the problem is awareness of the problem and the importance of public health interventions to beat back syphilis," Dobbs said. "We need to make sure to protect moms and babies, make sure that moms have access to early prenatal care, insurance and a clinic system that is attuned to diagnosing and treating these dangerous infections early."

Finley called the findings devastating, but not unexpected.

"The rates of congenital syphilis have exploded across the country," she said. "Mississippi has been hit much harder than other parts of the country. But when we look across the board, we see rates going up."

Finley said another well-funded public health push is needed to reverse the trend.

"But it would be difficult to have the maximum impact to focus exclusively on congenital syphilis. We would need something that addresses syphilis across the community," she said.

"After all, women who are pregnant get syphilis from somebody else, so to really have an impact, we need to test women during pregnancy. We need to provide them with treatment during pregnancy," Finley said. "We also need to make sure that their partners have access to testing and treatment so that if they do acquire an infection they can get quick treatment before they pass it on to their pregnant partner."

The report was published Sept. 20 in the journal Emerging Infectious Diseases.

More information

For more on syphilis, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Thomas Dobbs, MD, dean, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson; Elizabeth Finley, spokeswoman, National Coalition of STD Directors, Durham, N.C.; Emerging Infectious Diseases, Sept. 20, 2023