Babies born with dangerous infections: Syphilis in newborns up astronomically

Rates of syphilis in newborn babies have risen astronomically since 2012, largely because pregnant women have not been getting screened as often as they once were, according to a new report.

The reason, according to experts in infectious diseases, include less access because of clinics closing and greater difficulty in notifying partners, who can be more anonymous since the advent of the internet.

The Centers for Disease Control and Prevention reported that from 2012 to 2021, syphilis cases in newborns increased 755%, from 335 to 2,865 nationwide. 

‘Things start to show back up again’

The CDC’s report, “Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022,” said “lack of timely testing and adequate treatment contributed to almost 90% of congenital syphilis cases in the United States.” 

“Rates of syphilis in the United States reached an all-time low in about 2000,” according to Dr. Dana Dunne, a Yale School of Medicine infectious disease specialist.

“And a lot of funding for STD clinics and other public health partner notification and other kinds of supports around syphilis control started to get wound down, thinking that we had achieved control of syphilis,” Dunne said. “And then, of course, once you turn your attention away, things start to show back up again.”

“A major reason is that there’s been a reduced access to prenatal care,” said Dr. Thomas Murray, associate medical director infection prevention at Yale New Haven Children’s Hospital.

It’s a serious problem because syphilis, while easily treatable with penicillin, can have dire consequences.

“It can lead to stillbirth and death … and probably about 10 to 15% of babies born with congenital syphilis will be stillborn or a nonviable pregnancy,” Dunne said.

“And the remaining 85 to 90% will have … anything from brain consequences, so they’re going to have potential cognitive delay, skeletal abnormalities like bone, teeth, blindness, deafness,” she said.

Connecticut ranks low on the list, sixth from the bottom, at 16.8 per 100,000 population, according to Statista. Arizona and New Mexico rank 1 and 2, at more than 200 per 100,000. But Connecticut has not escaped the increase in occurrences of the disease.

“In the last 10 years, cases of congenital syphilis cases have increased in Connecticut,” Dr. Lynn Sosa, state epidemiologist and director of infectious diseases with the state Department of Public Health, said in an email.

“From 2012-2017, there was only one case of congenital syphilis diagnosed among Connecticut infants,” Sosa said. “Between 2018-2022, there were 20 cases diagnosed. So far in 2023, there have been 2 cases diagnosed.”

Timely testing is key

“This is a preventable infection … and it’s a combination of providers being aware of needing to make sure that they’re screening early and often,” Dunne said. There is a need, she said, “for us to just have a conversation about the access to care that might be barriers for people being able to be screened and treated.”

She said the rates of syphilis increased most in men who have sex with men, who also had sex with women. “It was really in that population to the extent that by 2015, the male-to-female ratio that had been one to one, pretty much, …. was now like 16 to one,” she said.

“The underlying problem is that this is a sexually transmitted disease that is not hugely symptomatic in people, so they may not know they have it,” said Dr. Juan Salazar, physician in chief for Connecticut Children’s Medical Center and an infectious disease specialist.

“But it’s very contagious and so it’s passed on, and symptoms can be very subtle, so it is often missed or not recognized by the people who have it, or the physicians who may see the patient and not do the testing that’s needed,” he said.

“The other reason there’s such an outcry is that it’s totally preventable by screening pregnant women and giving them appropriate therapy,” Dunne said.

That happens at hospitals and by obstetrician/gynecologists, but if women don’t see a doctor, the screening doesn’t happen.

“I would say about half of it looks like it’s people who didn’t get timely testing,” Dunne said. “So they might not have gotten any prenatal care at all and showed up and maybe people didn’t think of it or there wasn’t really any time where they did get tested.”

Timely treatment is important as well, she said.

Connecticut’s guidelines are to test in the first and third trimesters.

“If the mother comes here in Connecticut for prenatal care, they get all the testing done in the first trimester, which includes the syphilis test, and if that test is positive the mom gets treated,” Salazar said.

But Connecticut requires a second test in the last trimester because a mother can become infected during her pregnancy, he said.

“If you don’t have really good access to prenatal care consistently through the pregnancy, and you have high rates of syphilis in the general population, that’s the perfect recipe for disaster, which is what we’re seeing right now, with a lot of transmission from males to females of childbearing age, lack of early timely diagnosis in the mom, that then translates into congenital syphilis,” Salazar said.

Dunne said in more recent years it’s been more difficult to notify partners that they may have had sex with someone who was positive for syphilis — or other sexually transmitted infections — because of the internet.

In the 1980s and ’90s, “You were infected, you typically named one partner, that person was typically able to be found and treated,” Dunne said.

“When it started to go up in 2001 and onward in men who had sex with men, there was more internet hooking up,” she said.

“There was more of these newer … ways people were getting partners, and so it was harder to do partner notification, because sometimes the people didn’t have a name or they didn’t have a way that they could get them to say you’ve been exposed to syphilis, you need to go get tested and get treated,” she said.

Different symptoms; possible vaccine

Murray, a pediatrician, said once a baby is born, “if we’re worried that the baby could have syphilis, we do a very thorough evaluation to assess whether the baby has syphilis, and then we will treat with penicillin and we follow the baby over time to make sure that treatment has been appropriate and to document that the baby doesn’t have any signs of active disease.”

Babies don’t all present the same if they have syphilis, Murray said. “A baby can have no symptoms or a baby can be quite sick with pneumonia (or) an infection of the spinal fluid,” he said. “So a baby looking normal at birth, unfortunately, does not exclude the possibility that the baby has syphilis and then signs or symptoms of syphilis can show up later in childhood.”

Salazar said there’s another problem.

“Remarkably we’ve had shortages of penicillin in this country,” he said. “Part of the problem is that companies that made it, they don’t make a profit on it so they stopped making it. But we need generic companies that make generic medications to get back on this and generate penicillin so we can use it.”

However, he said, the National Institutes of Health sponsored research at the University of Connecticut School of Medicine, in conjunction with Connecticut Children’s, to develop a syphilis vaccine. Dr. Justin Radolf, professor of medicine and pediatrics at the medical school, is leading the research.

“Obviously, that is the ultimate solution is to come up with a vaccine that prevents the disease in the first place,” Salazar said. “We’ve made great progress. We are on the verge of really putting together something that can be brought to clinical trials and this would be first in the world.” 

He said they are working with Dr. Drew Weissman, who won the Nobel Prize in Medicine this year for his work on the mRNA vaccine, which was the basis for the COVID-19 vaccine.

Ed Stannard can be reached at [email protected].