Local Public Health Agencies Urge Vigilance and Action to Combat Rise in Congenital Syphilis Cases
(April 24, 2017) – In 2016, the rate of congenital syphilis in Missouri rose to the highest it has been in decades. The Saint Louis County Department of Public Health, the St. Louis City Department of Health, and the St. Louis STI Regional Response Coalition (STIRR) are joining together to call for vigilance and action by everyone in the local health community to address the problem.
“Sexually-transmitted infections are entirely preventable,” said Dr. Faisal Khan, director of the Saint Louis County Department of Public Health. “Everyone in local health community needs to be aware of the problem in order to combat this unacceptable increase.”
Missouri is not the only state affected by rising rates of congenital syphilis. The U.S. saw a 39% increase from 2012-2014. Preventative techniques, medical recommendations, and timely treatments are all being encouraged to both prevent congenital syphilis as well as ensure the health and safety of mothers, their sexual partner(s), and children.
“It is also critical that the local health community understand that risk factors outside of unprotected sex exist in the contraction and spread of syphilis,” said Dr. Fredrick Echols, director of the Division of Communicable Disease Control Services at the Saint Louis County Department of Public Health. “These include drug use, the diagnosis of another sexually-transmitted infection, new or multiple partners during pregnancy, and sex with non-monogamous partners.”
The Centers for Disease Control and Prevention (the CDC) recommends that pregnant women be tested for syphilis during their first trimester. Missouri law requires that such testing occur either during the first trimester or during the initial prenatal screening. In addition, since women who remain sexually active during their pregnancy can still contract syphilis, it is recommended that women continue to be screened for syphilis periodically throughout their pregnancy. Monitoring for syphilis is vital since an infection can cause abnormal fetal development, miscarriage, birth defects, and because it can be passed from mother to child during delivery.
Because of the high prevalence of primary and secondary syphilis in the St. Louis region, STIRR is recommending an additional screening for syphilis between 28 and 32 weeks and repeat testing at delivery for all pregnant women. This testing may be considered as early as 24 weeks.
Added Dr. Hilary Reno, director of STIRR, “Combining precision prevention methods and compassionate treatment options are steps the health community must take to prevent further maternal, partner, and infant exposure and infection with syphilis.”
Medical and other healthcare professionals are being reminded to follow all recommended testing and treatment protocols regarding pregnant women and congenital syphilis. In addition, local public health agencies are recommending the following for medical professionals:
Treatment for pregnant women who test positive for syphilis is vital. It has been shown that early detection and swift treatment more than 30 days before delivery dramatically decreases the number of congenital syphilis cases. Pregnant women with syphilis should be treated with benzathine penicillin. However, it should also be recognized that pregnant women, especially those who show fetal abnormalities on an ultrasound, are at increased risk for treatment failure and a second dose of penicillin G can be given one (1) week later for primary, secondary, or early latent syphilis. Patients with penicillin allergies should be desensitized and treated with penicillin.
With infants, consideration should be given to both live birth and stillbirth circumstances. In the case of a live birth, infants should not be discharged from the hospital without syphilis testing of the mother at least once during pregnancy and preferably again at delivery. Decisions for the evaluation and treatment of newborns should be based on the timing and treatment regimen of the mother and the history of ultrasound finding of the neonate. In the case of patients with a stillbirth after 20 weeks of pregnancy, testing for syphilis should also occur.
To control a congenital syphilis outbreak, other testing, evaluation, actions, and care should be considered. Screening for syphilis with nontreponemal antibody testing is typical, but reverse screening protocols using treponemal antibody testing are also acceptable. Since syphilis is a reportable illness, all incidents should be reported to the Missouri State Department of Health and Senior Services. The testing and treatment of partners should also be considered, especially to prevent reinfection during pregnancy. Encouraging prenatal care not only works to ensure a healthier pregnancy, but also increases the chances for early syphilitic symptom detection. Finally, syphilis infections are closely related to the risk of an HIV infection, so strong consideration should be given to testing for that as well.