COMMENTARY

Congenital Syphilis Is on the Rise? Reviewing Prevention Steps

Sarah Kidd, MD, MPH

Disclosures

July 18, 2016

Editorial Collaboration

Medscape &

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Hello. I am Sarah Kidd, medical officer in the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC) and coauthor of "Increase in Incidence of Congenital Syphilis—United States, 2012-2014," which was published in the Morbidity and Mortality Weekly Report in November 2015.[1]

Over the next few minutes, I will provide you with information about congenital syphilis, including the latest data trends and the critical steps that healthcare providers can take to protect pregnant women and their babies.

Our recent CDC report finds that after years of decline, the number of congenital syphilis cases reported in the United States increased between 2012 and 2014. Rates in our country are now higher than they have been in nearly 15 years. The increases occurred across all races and ethnicities, and in every region. Without a doubt, the data are very concerning. The resurgence of congenital syphilis points to missed opportunities for prevention within the public health and healthcare systems.

Syphilis infection during pregnancy can result in significant health problems for an infant. Historical data indicate that up to 40% of pregnancies in women with untreated syphilis will result in miscarriage, stillbirth, or infant death. Infants who live may develop severe illness, including skeletal abnormalities; hepatosplenomegaly; jaundice; anemia; optic atrophy; interstitial keratitis; sensorineural deafness; or meningitis, which can cause developmental delays and seizures. And yet, congenital syphilis is preventable.

We are calling on clinicians to get back to the basics of syphilis prevention for pregnant women. There isn't a new method to reverse this growing problem. We just need everyone to do what we know works—what has always worked. Here are actions you can take:

  • Screen all pregnant women for syphilis at their first prenatal visit. Some women may be in the asymptomatic stage of syphilis. Women who are asymptomatic can still spread the infection to their unborn babies.

  • Women at high risk should be rescreened early in their third trimester and again at delivery. This includes women with a history of syphilis infection, incarceration, drug use, [or] multiple or concurrent partners, and those who live in areas with high rates of syphilis.

  • If your patient is diagnosed with syphilis, take immediate action. Pregnant women diagnosed with syphilis should be treated with penicillin immediately.[2] Treatment at least 30 days prior to delivery is likely to prevent congenital syphilis. Also, all cases of syphilis and congenital syphilis should be reported to your state or local health departments right away. CDC recommends reporting within 24 hours.

  • Advise your patient to tell her sex partner or partners about the infection and encourage them to get tested and treated to avoid reinfection.

  • Before discharging any newborn infant from the hospital, make sure that the mother has been tested for syphilis at least once during her pregnancy or at delivery. If the test is positive, ensure that the mother and baby are evaluated appropriately before discharge and, if necessary, treated.[2] Also, if a woman delivers a stillborn infant, she should be tested for syphilis.

  • Keep in mind that the same tenets of quality sexually transmitted disease prevention apply to pregnant women, too. Take a sexual history throughout the course of your patient's pregnancy, and talk with her about prevention methods.

  • Partner with health departments, prenatal care providers, and other local organizations to address barriers to obtaining early and adequate prenatal care for the most vulnerable pregnant women in your community. Women who are uninsured or underinsured, and women with substance use issues, have been found to be at increased risk of receiving inadequate or no prenatal care, placing their unborn babies at risk for congenital syphilis.

For more information, please see CDC's Sexually Transmitted Diseases (STDs) website.

Web Resources

Syphilis During Pregnancy—2015 Sexually Transmitted Diseases Treatment Guidelines

Congenital Syphilis—2015 Sexually Transmitted Diseases Treatment Guidelines

Congenital Syphilis "Dear Colleague" Letter

Congenital Syphilis—CDC Fact Sheet

Sarah Kidd, MD, MPH, is a medical epidemiologist on the Surveillance Team in the Division of STD Prevention at CDC. Her primary responsibilities include monitoring, analyzing, and reporting trends in syphilis morbidity in the United States. A board-certified pediatrician, Dr Kidd is a graduate of the University of Washington School of Medicine and the Boston Combined Residency Program in Pediatrics. She also holds a Master of Public Health degree from the Harvard School of Public Health. Before coming to CDC, Dr Kidd worked as a primary care pediatrician in the United States and in southern Africa.

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