Congenital syphilis prevention planned for El Paso, Jefferson county jails

An effort to prevent serious and sometimes deadly congenital syphilis cases is getting started in the El Paso and Jefferson county jails after seeing success in Pueblo. 

Syphilis and other sexually transmitted infections are on the rise throughout the country and Colorado has not been immune. Across the state, syphilis cases are up from about 800 cases in 2017 to about 2,300 in 2021, according to the Colorado Department of Public Health and Environment. Preliminary data shows in 2022 the number was more than 3,000 cases across the state.

The reason for the increase is multifaceted, according to the Centers for Disease Control and Prevention, which reports the country has seen a decline in screening, treatment and prevention for sexually transmitted infections for many years. This spring, the country started experiencing a shortage of penicillin needed to treat syphilis cases that is expected to last until 2024, further compounding the problem. 

As syphilis has spread in Colorado, so has congenital syphilis with cases rising from 4 to 31 from 2017 to 2021, state data shows. In unborn children and infants, congenital syphilis causes miscarriage, stillbirth and neurologic impairments that can cause lifelong disabilities. 

About nine years ago the state didn’t have any congenital syphilis cases, said Lacy Mulleavey, prevention and field service program manager with CDPHE. But in recent years there has been a consistent increase.  

“These are babies and this is a completely preventable diagnosis. … We need to do our best to reach these individuals,” she said. If a mother can be treated 30 days before delivery, the condition can be prevented in the child.

The state health department offered El Paso and Jefferson counties grants to launch jail-based prevention programs because of their high case counts and existing sexual health resources, such as in-house labs for testing, she said. El Paso County had 260 cases of syphilis across the community last year and Jefferson County saw 227 cases, according to preliminary state health department data. 

Denver County saw the highest number with 1,097 syphilis cases. The state health department has talked with the Public Health Institute at Denver Health about potentially starting screening and treatment in the jail, said Gabi Johnston, a spokeswoman for CDPHE. The institute did not respond to a request for comment.

A key benefit of treatment in the jails will be connecting women to care quickly. 

Nationally, about a third of the time moms who passed on syphilis were diagnosed with syphilis early in pregnancy when it is highly treatable, but they did not receive the penicillin necessary to cure it, said Dr. Paul Mayer, co-medical director of El Paso County Public Health. While some syphilis cases can be treated with a single shot, cases more than 12 months old with no visible signs or symptoms need three shots over three weeks, according to the Centers for Disease Control and Prevention.

“This is a population that can struggle a lot with stability,” he said. 

In addition, some mothers do not seek prenatal care at all and so syphilis isn’t detected until the child is born, Mulleavey said. 

The new programs are aimed at reaching women in jail because a high rate of women who pass along syphilis to their children are involved in the criminal justice system while pregnant, said Summer South, Reproductive Health Clinic program manager for El Paso County Public Health. Some other risk factors for syphilis include multiple sex partners, substance use disorders, poverty, sex work, homelessness or unstable housing, according to the CDC. 

The El Paso County Health Department expects to offer 1,200 screenings during the first year of the program funded by a one-year, $290,838 grant, she said. It is likely female inmates will be screened multiple times, in part, because there is no vaccine for syphilis and those who have had the condition do not develop immunity. 

The new voluntary program for female inmates will offer screening and treatment the same day or the next day while they are still incarcerated, Mayer said. The screenings will cover other sexually transmitted infections as well and include education on preventing the spread. South said she expected the program to start soon, but a date has not been set. 

In Jefferson County, the prevention program will look similar, with a goal of 1,200 screenings a year paired with testing for other sexually transmitted infections and prevention education, said Hisae Tsurumi, an advanced practice registered nurse supervisor with the county’s public health department. The state expects to provide Jefferson County Public Health with a $441,009 grant, Johnston said. 

To encourage women who test positive to come back for additional shots if necessary, the department expects to offer financial incentives such as gift cards, Tsurumi said. For women who are homeless, the department has contracted with Recovery Works, a homeless shelter, to provide housing for those who need additional treatment after release. 

“We are really trying to have a wrap around approach to make sure no one falls through the cracks,” she said. 

The department also plans to study its prevention work to understand the most effective ways to encourage patients to come back for follow-up treatment, Tsurumi said. 

The program is expected to start in late August or early September following a warm welcome from Jefferson County Jail, she said. 

“They have been extremely receptive to implementing this project with us,” she said. 

In Pueblo, where the jail-based treatment has been running for a year and a half, 388 women of reproductive age have been screened, with a positivity rate of 27.3%. Thus far, 78% of those diagnosed have been successfully treated. The program also identified seven cases among pregnant women and all of them completed treatment, according to the state health department. 

As the program in Pueblo has matured health officials have started to treat some women outside of clinical settings, such as their homes, to ensure they receive necessary shots. The field work reached 17 women, including five pregnant women. 

Mulleavey said she felt the data from Pueblo showed the prevention programs are getting introduced in the right places where they can be effective. 

“I think this is a great start,” she said.