Congenital Syphilis Cases in the US Highest in 25 Years

By Gene Emery

September 16, 2021

NEW YORK (Reuters Health) - Syphilis in children is on the rise again in the United States.

A new analysis by the Centers for Disease Control and Prevention (CDC) has found that the number of congenital syphilis cases in 2020 increased by 8% over the previous year, with more cases left to count. That's nearly six times higher than in 2012, when the number reached a recent nadir.

The 2,022 cases among children born in 2020 "already surpasses the 1,870 cases reported in 2019, represents the highest case count since 1994, and is likely to continue to rise until the reporting period ends in October 2021," reports the CDC team, led by Dr. Virginia Bowen, in the New England Journal of Medicine.

The team says the final count could be closer to 2,100.

When the mother is infected, it can lead to miscarriage, stillbirth, premature delivery, underweight babies and infant death. If undiagnosed in her child, it can produce liver problems, neurologic defects and bone deformities.

"We haven't seen anything like this in 25 years," Dr. Bowen told Reuters Health by a phone. "We've now surpassed 2,000 cases of a perinatal condition that is completely preventable, where we have a treatment that works and there's no resistance to this treatment. Even one case of congenital syphilis is a sign that something has gone amiss. This is super concerning."

The increases are being seen in 32 states and the District of Columbia.

The disease was fatal in 139 of the 2,022 children.

The reason for the continued increase is unclear but the data do show "some missed opportunities for care," said Dr. Bowen, an epidemiologist in the CDC's Division of STD Prevention.

"For more than one-third of these babies, their moms got no prenatal care or they got care so late there wasn't time to prevent congenital syphilis. So that's about 35% of all of our babies," she said. "And then you have another 40% of our case infants where their mothers got tested, but they just were not treated in time. So there are some gaps we want to close in prenatal care and in timely treatment once a woman receives a diagnosis of syphilis."

The team says the sexually transmitted disease is no longer concentrated in the U.S. South and urban areas. Half the counties in the United States have reported cases among women.

While Louisiana was the only state to have a syphilis rate that was higher than 50 per 100,000 women age 15 to 44 in 2010, Mississippi, Arkansas, Oklahoma, New Mexico, Arizona, Nevada, California and Alaska had joined the list by 2019.

Of the cases reported in 2020, 693 were among Blacks, 610 were among Hispanic or Latinos and 500 were among whites.

Doctors are supposed to screen for syphilis at the first prenatal visit but six states don't require any syphilis testing.

In 1994, the last time the numbers were this high, there were 2,452 cases. In 1991, there were 4,424.

But from there, the numbers dropped to the point where "by the late 1990s we were approaching a place where we thought we might eliminate syphilis," Dr. Bowen said. "That's what makes this super alarming. We're almost back to where we were."

SOURCE: The New England Journal of Medicine, online September 15, 2021.