Five Stillbirth and Neonatal Deaths This Year Related to Congenital Syphilis

PRESS RELEASE — The North Carolina Department of Health and Human Services is issuing a public health alert following five stillbirths or neonatal deaths in babies with congenital syphilis born between Jan. 1, 2023, and Sept. 1, 2023. This alert follows a provider memo issued last week by NCDHHS asking for health care providers’ help to prevent congenital syphilis and reverse the alarming trend. Previous provider memos from NCDHHS were released Dec. 20, 2022, Nov. 15, 2021, and Nov. 9, 2018.

From 2012 to 2022, there was a 547% increase in reported syphilis cases in North Carolina among women with an associated increase in congenital syphilis infections, from 1 case in 2012 to 57 cases in 2022. This increase mirrors the national trend as described this week by the Centers for Disease Control and Prevention’s Vital Signs: Missed Opportunities for Preventing Congenital Syphilis – United States, 2022 and the increase previously reported by NCDHHS.

Congenital syphilis is preventable. If left untreated, syphilis in pregnancy can result in miscarriages, stillbirth and neonatal death, as well as adverse life-long health impacts for the baby such as bone damage, severe anemia, enlarged liver and spleen, jaundice, nerve problems causing blindness or deafness, meningitis, or skin rashes. Public health agencies review each case of congenital syphilis in the state to understand why the infections were not prevented. A review of North Carolina’s 2022 congenital syphilis cases identified the following missed opportunities:

• Little to no prenatal care
• Missed opportunities to test women during pregnancy, as required by North Carolina’s Public Health law
• Inadequate or delayed treatment of the maternal syphilis infection

All pregnant women should be screened at least three times during pregnancy. Sexually transmitted infections can still be present even if the exposure was in the past and even if there are no symptoms. In 2022, 86% of pregnant women diagnosed with syphilis in North Carolina did not have symptoms at the time of diagnosis. Symptom-based testing alone would have missed these infections.

In addition, because many mothers of infants with congenital syphilis had little or no prenatal care, it is important for health care providers to screen pregnant women for syphilis in other settings, such as urgent care or emergency room visits.

Every person deserves to have a healthy pregnancy and baby, and women should be tested throughout their pregnancy to address sexually transmitted infections.

This is one of multiple ongoing efforts by NCDHHS to address the increase in syphilis. Other recent initiatives include convening a Southeast Congenital Syphilis Payers Summit to identify policy levers payers can use to address this growing epidemic. NCDHHS will continue efforts to raise awareness and address this issue with a provider education campaign; a public education campaign to spread awareness of syphilis and the importance of testing, so pregnant women and the people who love them have access to information and treatment; and increasing access to syphilis testing by distributing point-of-care tests. You can find more information on this on the NCDHHS Public Health website.