MMWR: Congenital syphilis cases have surged in the United States

Congenital syphilis poses serious risks during pregnancy, including miscarriage, stillbirth, infant mortality, and maternal and infant health issues.

Takeaways

Congenital syphilis is on the rise in the United States, with a staggering 755% increase in reported cases from 2012 to 2021, posing significant risks to maternal and infant health.
The increase in cases has led to a surge in stillbirths, infant deaths, and serious health consequences for both mothers and babies, highlighting the urgency of addressing this public health issue.
Timely testing and appropriate treatment during pregnancy can prevent the transmission of syphilis from mother to child, making early detection and intervention crucial in combating the problem.
The CDC recommends syphilis screening during the first prenatal care visit, and for those with limited access to care, testing should occur as soon as the pregnancy is identified, with additional screenings at 28 weeks of gestation and during delivery for high-risk individuals.
To combat the rising rates of congenital syphilis, addressing both patient-level and systemic barriers, such as substance use, insurance status, limited healthcare access, and medication shortages, is essential to control the epidemic and protect maternal and infant health.

According to a recent Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC), there has been a significant surge in congenital syphilis cases in the United States since 2012, with a staggering 755% increase from 2012 to 2021.

During this period, reported cases rose from 335 in 2012 to 2,865 in 2021. Perinatal transmission of syphilis can be prevented through timely testing and appropriate treatment during pregnancy.

The CDC advises syphilis screening during the first prenatal care visit. In cases where access to prenatal care is limited, testing should occur as soon as the pregnancy is detected. Additionally, screenings are recommended at 28 weeks of gestation and during delivery for women living in areas with high syphilis rates, those at high risk for syphilis acquisition during pregnancy, or those who were not previously tested.

To identify missed prevention opportunities, a study featured in the MMWR developed a six-part cascading framework of risk factors, which includes:

The study utilized congenital syphilis cases reported to the CDC's National Notifiable Diseases Surveillance System (NNDSS) in 2022. These cases were categorized based on timely testing during pregnancy, and they adhered to the 2018 Council of State and Territorial Epidemiologists congenital syphilis case definition.

In 2022, there were 3,761 reported cases of congenital syphilis. This total included 6% stillbirths (231) and 84% liveborn infants (3,530). Among these cases, there were 51 infant deaths (1%), representing a 31.7% increase compared to 2021. Additionally, a concurrent 17.2% increase in primary and secondary syphilis cases among females aged 15 to 44 years was observed.

The majority of birth parents (87.8%) received no or untimely testing (1,385) or no or undocumented testing (423). Inadequate treatment during pregnancy was reported in 39.7% of cases (1,494). Late diagnosis of syphilis during pregnancy following an earlier nonreactive test occurred in 5.2% of cases (197).

Results showed that 57.9% of cases (2,179) had timely testing and no late identification of syphilis. However, nearly 40% (1,494) had documented inadequate treatment, around 20% (423) received no treatment or had undocumented treatment, and the remaining 12% (262) received adequate treatment.

Geographically, the West (56.2%) and Northeast (50.0%) Census Bureau regions had the highest percentage of cases involving no testing or untimely testing. The category of no testing or untimely testing was the most common missed care opportunity for non-Hispanic American Indian or Alaska Native (47.4%), non-Hispanic Black or African American (39.2%), and Hispanic or Latino (47.4%) birth parents.

Furthermore, 37.9% of pregnancies resulting in congenital syphilis had no documented prenatal care. In 2022, a lack of timely testing and adequate treatment during pregnancy contributed to 88% of congenital syphilis cases.

The CDC reported that the United States is facing the highest rates of congenital syphilis in 30 years, with multiple barriers to prevention at both the patient and system levels. Patient-level barriers include substance use and insurance status, while system-level barriers encompass limited access to healthcare, medication shortages, and structural inequities. The report emphasized that enhancing timely testing and appropriate treatment, along with addressing these barriers at the local and national levels, is crucial to controlling the congenital syphilis epidemic in the United States.

Vital signs: Missed opportunities for preventing congenital syphilis – United States, 2022. Morbidity and Mortality Weekly Report. November 7, 2023. Accessed November 9, 2023. https://www.cdc.gov/mmwr/volumes/72/wr/mm7246e1.htm?s_cid=mm7246e1_w