Congenital syphilis on the rise

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

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

About 7 percent of babies diagnosed with syphilis in recent years have died; Thousands of people born with the disease have faced problems including brain and bone malformations, blindness, and organ damage.

For public health officials, the situation is even more harrowing when you consider that rates of congenital syphilis hit near-record modern lows between 2000 and 2012 amid ambitious prevention and education efforts. By 2020, following a sharp erosion in funding and care, the national case rate was more than seven times higher than it was in 2012.

‘It’s a scandal’: Rising rates of congenital syphilis put babies in grave danger

“The really depressing thing is that we pretty much eradicated this in 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 the number of cases skyrockets, the CDC’s budget for STD prevention, the main source of funding for most public health departments, has largely stagnated for two decades, and their purchasing power has been further reduced by 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 rise in already overwhelmed states like Texas, California, and Nevada and that 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 is killing babies in the US. A reason? The CDC budget.

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

Preventing congenital syphilis, the term used when syphilis is transferred to the fetus in the womb, is extremely simple from a medical point of view: If a pregnant person is diagnosed at least one month before giving birth, only a few few injections of penicillin have an almost perfect effect. cure rate for both father and baby. But funding cuts and competing priorities in the nation’s fragmented public health system have greatly reduced access to such services.

The reasons 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, most cases involve patients who have received little or no prenatal care and are not tested for syphilis until after delivery. 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 high-risk pregnancies.

In southern states, a CDC study of 2018 data found that most cases of congenital syphilis were among women who had been tested and diagnosed but had not received treatment. That year, among black mothers who gave birth to a baby with syphilis, 37 percent had not received adequate treatment despite receiving a timely diagnosis. Among white mothers, that number was 24 percent. Long-standing racism in health care, poverty, transportation problems, underfunded public health departments and overcrowded clinics whose employees are too overworked to keep track of patients all contribute to the problem, 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 who are treated for syphilis but become reinfected during pregnancy. Amid rising cases and stagnant resources, some states have focused disease investigations on pregnant people of childbearing age; they can no longer prioritize treating sexual partners who are also infected.

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

Treating a newborn baby for syphilis is not trivial. Penicillin carries little risk, but giving it to a baby often involves a spinal tap and other painful procedures. And treatment usually means keeping the baby in the hospital for 10 days, interrupting an important time for family bonding.

McGrath has seen a couple of babies in his career who were undiagnosed and untreated at birth and later came to him with full-blown syphilis complications, including full-body rashes and liver inflammation. 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 the test at some point during pregnancy, as of last year only 14 required it for everyone in the third trimester. The CDC recommends third-trimester testing in areas with high rates of syphilis, a growing part of the United States.

STD rates remained high during the first year of the pandemic

After Arizona declared a statewide outbreak in 2018, state health officials wanted to know if widespread testing in the third trimester might have prevented infections. Looking at 18 months of data, the 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. That left 57 babies born with syphilis, nine of whom died. Analysts estimated that a third of infections could have been prevented by testing in the third quarter.

Based on the numbers they saw in those 18 months, officials estimated that testing all women with Medicaid in the third trimester would cost the state $113,300 a year, and that treating all syphilis cases that would be detected could be perform for only $113. Considering the costs of hospitalization for infected babies, officials concluded that additional testing would save the state money.

And yet it has been difficult to get money for prevention. Adjusting for inflation, CDC STD prevention funding has fallen 41 percent since 2003, according to an analysis by the National Coalition of STD Directors. That is even as cases have increased, leaving public health departments with more work to do and far less money.

Janine Waters, director of the New Mexico STD program, has watched the unraveling.

When Waters began her career more than 20 years ago, she and her colleagues followed up on every reported case of chlamydia, gonorrhea and syphilis, not only making sure people received treatment, but also contacting their sexual partners, with the goal of stopping the spread of infection. In a 2019 interview with Kaiser Health News, she said members of her team were struggling to keep up with syphilis on their own, even as they checked in with fearsome cases of congenital syphilis that were on the rise in neighboring Texas and Arizona. .

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

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

Experts: Massive push for coronavirus testing stalled detection, fight against STDs

As the pandemic subsides, at least in the short term, many public health departments are turning their attention to syphilis and other diseases. And they are doing it with reinforcements. Although the Biden administration’s proposed STD prevention budget for 2023 remains stable, the American Rescue Plan Act included $200 million to help health departments boost contact tracing and covid-19 surveillance. and other infectious diseases. Many departments are funneling that money into STDs.

The money is an infusion that state health officials say will make a difference. But when you factor in inflation, it basically brings STD prevention funding back to what it was in 2003, said Stephanie Arnold Pang of the National Coalition of STD Directors. And money from the American Rescue Plan doesn’t cover some aspects of STD prevention, including clinical services.

The coalition wants to revive dedicated STD clinics, where people can go for testing and treatment at little or no cost. Advocates say that would fill a void that has plagued treatment efforts since public clinics closed en masse in the wake of the 2008 recession.

Texas, battling its own widespread outbreak, will use its share of the American Rescue Plan money to fill 94 new positions focused on various aspects of STD prevention. Those hires will bolster a variety of measures the state put in place before the pandemic, including an updated data system to track infections, review boards in major cities that examine what went wrong in each case of congenital syphilis, and a requirement that Providers perform screening tests. syphilis during the third trimester of pregnancy. The package of interventions appears to be working, but it could be some time before cases decline, said Amy Carter, the state’s congenital syphilis coordinator.

“Growth didn’t happen overnight,” Carter said. “So our prevention efforts are also not going to have a direct impact overnight.”

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

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