Syphilis was nearly wiped out in the United States under the leadership of Gail Bolan, the director of the Division for Sexually Transmitted Disease (STD) Prevention at the Centers for Disease Control and Prevention (CDC). However, in the last four years, syphilis has made a comeback and it has particularly been affecting newborns at high rates.
From 2015 to 2017, the rate of syphilis in newborns has doubled, increasing to 23.3 cases per 100,000 live births.
Congenital syphilis is a life-threatening infection transferred from a pregnant mother to the fetus. Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum and can be divided into four stages: primary, secondary, latent and tertiary.
The primary stage of syphilis is often diagnosed by the onset of sores where syphilis entered the body. These sores are often painless and can easily go undetected. Without treatment, the infection proceeds to the secondary stage.
In the secondary stage, skin rashes and/or mucous membrane lesions begin to develop. Mucous membrane lesions are sores found in the mouth, vagina or anus. Although these symptoms may disappear even without treatment, the infection itself still progresses to the latent stage: a period without signs and symptoms, and the infection can linger for up to several years in this stage.
Most individuals with untreated syphilis do not progress to the final tertiary stage. However, in the unfortunate few who do, syphilis begins to take a toll on the organ systems including the heart, brain and nervous system, which can result in death. Fortunately due to the nature of the infection, syphilis can be cured with the right antibiotics.
In recent years, despite the curability of the infection, syphilis diagnoses have continued to rise among pregnant women, thereby increasing the number of affected infants born with congenital syphilis.
Bolan commented on how this trend can be changed in an interview with the New York Times.
“Congenital syphilis is a needless tragedy,” she said. “It is going to take all sectors of our society to help if we’re going to be able to reverse these trends — the health care and public health sectors, communities, decision makers, researchers and industry.”
Congenital syphilis is highly life-threatening. Nearly 50 percent of children affected by a mother diagnosed with syphilis die before or shortly after birth. However, this rate decreases with treatment. The answer lies in penicillin.
Syphilis screening for all pregnant women is recommended by the CDC, with emphasis placed during the first trimester. With early diagnosis, doctors can easily treat syphilis with penicillin, which can decrease the probability of transmission from mother to newborn.
Sarah Kidd, an epidemiologist in the Division of STD Prevention at the CDC spoke about the issue in a press release.
“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,” Kidd said.
The risk of transmitting the infection from the infected mother to the fetus is about 60 to 80 percent, as reported in the Merck Manual of Diagnosis and Therapy. If untreated, this percentage increases during the second half of the pregnancy and often introduces a high risk of stillbirth and neonatal death.
Even though syphilis is cured with one injection of penicillin, it’s still possible to become re-infected. Therefore it is highly recommended that pregnant women, especially those in the third trimester, receive continuous evaluations for syphilis. This is important because symptoms for syphilis are not always visible and can often go undetected.