July 21, 2017 — Chantal, a 27-year-old from Fresno County, CA, had no symptoms when she tested positive for syphilis at 7 months pregnant.
By the time she was treated, it was too late for her son.
Her baby — born at 8 pounds, 13 ounces in mid-March — is blind in one eye and may have a host of other health problems associated with congenital syphilis.
“I have seen pictures of my baby’s eyes, and the retina in the right eye looks purple,” said Chantal. “The left eye looks rotten.”
Syphilis, an old scourge that was nearly wiped out in the United States, is now back — and at alarming rates among newborns in all regions of the country.
“It’s very difficult to see these babies born with significant problems from a disease that was discovered almost 500 years ago,” said M. Nael Mhaissen, MD, a pediatric infectious disease specialist at Valley Children’s Hospital who treated Chantal and her son.
Public health officials blame lack of education, poverty, and drug use linked to prostitution for fueling the epidemic.
Between 2012 and 2015, the rate of congenital syphilis rose 46%, from 334 to 487 cases, according to data from the CDC.
That’s 12.4 cases per 100,000 live births, the highest numbers since 2001.
Louisiana (83.9 per 100,000 live births), California (28.5), and Maryland (25) had the highest rates among newborns in 2015. African-American and Latino mothers were hardest hit, with 8% and 3.5% higher rates of the disease, respectively, compared with white mothers.
“These are epic proportions, and we are dealing with this new reality,” said Beni Adeniji, MD, a maternal-fetal medicine specialist at Valley Children’s Hospital in central California.
Syphilis is highly contagious. It’s caused by a bacteria and is spread through unprotected vaginal, anal, or oral sex. The disease can pass from an infected mother to her unborn child.
This spike in cases comes even though syphilis is easily treatable with penicillin, a drug that has been around since the 1940s. A single injectable dose of penicillin, given to the mother immediately after diagnosis and within 30 days of delivery, can in most cases lower the chance of transmission to both mother and child. If a baby is born with the disease, doctors can treat it with a 10-day course of antibiotics or one injected dose.
CDC studies reveal that among all 458 mothers of babies with the disease in 2014, 100 had received no prenatal care and 44 had received no information about the disease.
“When we miss these opportunities to screen and treat pregnant women for STDs, the results, such as babies being born with syphilis, can be devastating,” said Sarah Kidd, MD, an epidemiologist in CDC’s Division of STD Prevention.
The CDC recommends all pregnant women get tested for syphilis (as well as HIV and hepatitis B) during the first prenatal visit. Those who live in areas of high risk — California’s Central Valley, for example — should be tested again about 28 weeks in the third trimester.
Once treated, women can still be reinfected and need to make sure they continue with testing.
The first sign of syphilis is a painless sore on the outside of the genitals, anus, or in the rectum. The sore may also appear on the lips and in the mouth. But many cases have no symptoms, especially in women. People without symptoms may not know they have the disease and pass it on to others.
An Uncertain Future
Chantal, who used only her middle name for privacy reasons, didn’t get treated until the final weeks before her son was born, which was too late for him. Antibiotic treatment can halt the disease, but it can’t reverse the damage caused before birth.
Without treatment, 40% of infected infants will be stillborn or die from the infection soon after birth, according to the CDC. Those who survive can have lifelong paralysis, hearing loss, blindness, profound skeletal deformities, and brain damage.
Syphilis had almost disappeared in the United States by 2000. But after the recession of 2008, an estimated 69% of STD prevention programs saw budget cuts, and the number of health clinics dropped by 10%, according to a 2009 survey by the National Coalition of STD Directors.
That trend has continued, and sex education programs have also steadily declined nationwide, says Jeffrey D. Klausner, MD, a professor of medicine and public health at UCLA’s David Geffen School of Medicine.
“Because congenital syphilis is one of the most preventable conditions, it’s the canary in the coal mine of our public health system,” he said.
With the current debate in Congress over whether to repeal Obamacare and the threat of leaving millions more Americans uninsured without access to prenatal care, Klausner says syphilis could make a comeback.
After infection rates tripled in the New Orleans area, Louisiana authorities issued a health alert in 2016 to all doctors and health workers to increase awareness about the crisis.
“Some providers said, ‘Wow, we have never seen a case in 20 years,’ ” said DeAnn Gruber, director of the infectious diseases bureau for the Louisiana Department of Health.
With the help of the CDC, Louisiana has established nine public health regions and active medical task forces
Preliminary numbers for 2016 appear to be going down, said Gruber. “We are really hopeful for 2017.”
Nicholas Van Sickels, MD, an infectious disease specialist with the Tulane University School of Medicine, treats patients with HIV. About one in every five also tests positive for syphilis.
“In the Deep South, we have the highest rates of HIV new infections in the nation, and where HIV goes, syphilis goes,” he said.
“When we see these really high rates, our approach should be, we’re testing everyone now — even grandmothers in nursing homes, street workers, everyone,” said Van Sickels. “I even asked my mom to be tested.”
Maternal substance abuse also adds to the problem, says Brian Barkemeyer, MD, a professor of pediatrics specializing in neonatology at the Louisiana State University School of Medicine.
In California and Louisiana, public health officials are working aggressively to test for syphilis twice during pregnancy and to make sure infected women notify their partners so they, too, are treated.
But often, women like Chantal have multiple partners. Or, if they are sex workers, they don’t even know their sexual partner’s identity.
I don’t know who it was who infected me,” she said, “and I couldn’t tell them.”
Chantal described the road ahead for her child. “We will not let it define us,” she said. “It’s just my past — that’s it. We are going to get through it.”
“I want people out there to know — always use protection, no matter how long you know the person,” said Chantal. “Get tested, and get tested again. You never know. ”