Congenital syphilis on the rise while Montgomery County a high area for syphilis in adults
Nov. 21—Congenital syphilis has increased tenfold over the last decade in the U.S. And with Montgomery County being the fifth highest county in Ohio for the rate of women of child-bearing ages who have had syphilis, public health officials are urging women to get tested regularly.
More than 3,700 babies were born with syphilis in 2022 in the U.S., which was more than 10 times the number in 2012, which was 335 cases, new data from the Centers for Disease Control shows.
"Congenital syphilis cases are at the highest level nationally that they've been in at least the last 30 years," said Dr. Becky Thomas, medical director at Public Health — Dayton and Montgomery County.
In 2022, a total of 3,761 cases of congenital syphilis in the U.S. were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths.
Local doctors have reported seeing a steady increase in infants hospitalized due to congenital syphilis.
"During the past three-plus years I've been here, we've seen a gradual yearly increase in the numbers of infants with congenital syphilis who are hospitalized at Dayton Children's Hospital," said Dr. Michael Klatte, chief of infectious disease at Dayton Children's.
This increase was not surprising to him, Klatte said.
"Montgomery County, where Dayton's at, has the fifth highest rate of all 88 counties in Ohio of women of child-bearing age having primary and secondary syphilis," Klatte said.
The rise of congenital syphilis parallels the rise in syphilis cases in women of child-bearing age, Thomas said.
"Montgomery County has been identified by the CDC as being in the top third of counties in the United States for having a high rate of syphilis among women of child-bearing age, and we're seen an increase in syphilis cases in Montgomery County each year since 2018," Thomas said.
The five-year average from 2018 to 2022 of syphilis cases in Montgomery County among women ages 14 to 45 is 56, according to Public Health. In 2023, there have been 83 syphilis cases so far.
In 2021, Montgomery County had a rate of 28.7 cases of primary and secondary syphilis among women aged 15 to 44 per 100,000 people, according to the CDC.
"The CDC's recent study shows that, for congenital syphilis, we're seeing women not getting prenatal care before birth and not getting tested and treated in time to prevent congenital syphilis," Thomas said. Those factors contributed to 88% of cases of congenital syphilis, researchers said.
In most cases, a course of antibiotics completed 30 days before birth will prevent cases of congenital syphilis, Thomas said.
Congenital syphilis causes an increased risk of stillbirth anywhere between a 5% increase to upwards of 45%, Klatte said.
Of live-born infants with congenital syphilis, approximately half have abnormally low birth weights, which can lead to additional health problems for babies.
The risk of death of a live-born infant with congenital syphilis is low, Klatte said.
"It's important to recognize cases of congenital syphilis in a timely manner," Klatte said.
If it is not caught early on in life, or within the first few months, babies with congenital syphilis are at risk of developmental delays, deafness, abnormal bone and teeth growth and development, and sometimes in rare cases even blindness, he said.
Infants with proven congenital syphilis need to be treated with 10 days of IV penicillin, all in the hospital setting, Klatte said.
The infants also undergo additional evaluations, including various imaging and x-rays, to monitor their condition. If they're treated within the first few months of life, the risks of long-term problems and issues with bones are lower, Klatte said.
Doctors and the CDC encourage getting mothers tested and treated in a timely manner and meeting those individuals where they're at as there can be a number of socioeconomic factors preventing women from getting tested or following up with a health provider, Klatte said.
"Syphilis slowly crept up starting in 2009, and as time progressed, now we have this epidemic," said Dominique Ayres, disease intervention supervisor at Public Health.
In the early 2000s, Public Health saw about seven cases of syphilis a year.
"On a day-to-day basis, I can assign seven or more cases for follow up and that's just daily, so we've drastically changed," Ayres said. "I don't think there's enough education."
Syphilis can also imitate other diseases and get misdiagnosed, she said. She has seen misdiagnoses like Rocky Mountain spotted fever, which is a bacterial disease spread through the bite of an infected tick, along with other cases misdiagnosed as HSV or genital herpes.
"It has symptoms that can mimic or mirror other infections," Ayres said.
Public Health encourages health providers to screen all of their patients for syphilis, especially if the patient is sexually active, Ayres said. Health providers are encouraged to make test for syphilis part of annual screenings, even if the patient doesn't present a high risk for contracting syphilis.
Pregnant women should also get tested for syphilis, and Public Health recommends getting one or two more tests done during the course of the pregnancy.
For more resources, visit stifacts.org.
------
By the numbers
In 2022, a total of 3,761 cases of congenital syphilis in the U.S. were reported to Centers for Disease Control, including 231 (6%) stillbirths and 51 (1%) infant deaths.
In 2012, there were 335 cases of congenital syphilis, revealing a tenfold increase over the past decade.
Almost nine in 10 cases of newborn syphilis in 2022 might have been prevented with timely testing and treatment during pregnancy.
More than half were among people who tested positive for syphilis during pregnancy but did not receive adequate or timely treatment.
Nearly 40% were among mothers who were not in prenatal care.
In 2021, more than 70% of the U.S. population lived in counties considered to have high rates of syphilis among reproductive-age women
