Neonatal syphilis cases at highest level in 30 years: CDC

Cases of neonatal syphilis are rapidly increasing in the United States, and federal health officials are sounding the alarm and calling for action.

New data from the Centers for Disease Control and Prevention (CDC) shows cases are at their highest level in at least 30 years. More than 3,700 infants will be born with syphilis in 2022, a tenfold increase over the past ten years.

Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and lifelong medical problems for both mother and baby. However, syphilis is easily preventable if people can get it through screening and treatment.

Benzathine penicillin G is the preferred treatment for syphilis in pregnancy, and is currently rare. Pfizer, which is the only company making the drug, said it would take at least until the second quarter of 2024 to ramp up production enough to end the shortage.

Nearly 90% of neonatal syphilis cases in 2022 could have been prevented with timely testing and treatment during pregnancy, according to the CDC. Last year, more than half of all cases involved people who tested positive for syphilis while pregnant but did not receive adequate or timely treatment.

The epidemic is hitting people from racial and ethnic minority groups hardest. While cases of neonatal syphilis are increasing overall, babies born to Black, Hispanic, or American Indian/Alaska Native mothers were up to eight times more likely to have neonatal syphilis in 2021 than babies born to white mothers, the CDC said.

Lack of timely testing and adequate treatment has contributed to significant proportions of cases across all geographic areas and racial and ethnic groups.

“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” said Debra Houry, CDC chief medical officer. “Already strained public health systems and the growing STI epidemic have brought our country to a tipping point with neonatal syphilis. Health care and public health systems are scrambling to prevent moms and babies from falling through the cracks in every way possible.

The CDC also recommended regular geographic screening to reduce stigma and bias associated with screening based on individual risk factors. For many people, the biggest risk factor is living in a community with high rates of syphilis, and much of the country is now considered to have high rates of spread.

Forty percent of cases of neonatal syphilis occurred in people who did not receive prenatal care. Every encounter a person has with a health care provider during pregnancy can be an opportunity for prenatal care and syphilis testing, the agency recommended. This includes visits to emergency departments, needle service programs, substance abuse treatment centers, and maternal and child health programs.

The CDC said it encourages providers to consider using a rapid syphilis test and starting treatment with the first positive test for patients who may experience barriers to regular, high-quality medical care.

“By treating patients quickly rather than waiting for the results of a follow-up test and requiring another visit, we can reduce some of the biggest barriers to the care others need,” said Laura Bachmann, chief medical officer of the CDC’s STD prevention division.