'Time to sound the alarm': Surge in babies born with syphilis draws attention to lack of care

A surge in babies born with congenital syphilis in Mississippi calls attention to rising cases throughout the nation, especially the South, experts say.

In 2021, the state saw 106 cases, more than nine times the rate in 2018, when 11 cases were reported, according to an analysis of hospital discharge data from Dr. Thomas Dobbs, a University of Mississippi Medical Center infectious disease physician, and state epidemiologists Dr. Paul Byers and Manuela Staneva. 

The analysis first gained attention when Dobbs, a former state health officer, posted the data to Twitter. The preliminary figures haven't yet been published by the Mississippi State Department of Health.

The analysis raises concerns about lack of access to prenatal care and persistent disparities, experts say, highlighting the need for better screening protocol. Mississippi is one of eight states that does not require syphilis screening during pregnancy, according to the Centers for Disease Control and Prevention. Few states require screening during the third trimester and delivery.

In recent years, syphilis cases have tripled across the United States, according to the CDC. 

In 2018, the South, a region plagued by structural racism and numerous disparities, accounted for more than half – 52% – of the nation’s 1,300 cases. More than a third were in the West. About 21% were among Hispanic women, and roughly 40% of those cases were among Black women, who already see disproportionate maternal and infant death rates.

Along with the lack of required screening, “mothers cannot access prenatal care, either due to difficulties in the system itself or difficulties that they face on an individual level," said Dr. Charlotte Hobbs, a pediatric infectious disease physician at the University of Mississippi Medical Center.

They're "in an area that already has such high prevalence of infection," she said. "It's just a recipe for disaster."

What is syphilis?

Syphilis is a sexually transmitted infection that can cause severe health problems. It’s curable by antibiotics.

Congenital syphilis occurs when a mother with untreated syphilis passes it on to the baby. The disease can cause infant death, stillbirth, miscarriage, low birth weight, developmental problems such as bone deformations, and brain and nerve problems such as blindness.

Babies born with syphilis often don’t show symptoms. That’s why the CDC urges testing for syphilis at least once during pregnancy – during the first prenatal visit or during the first trimester, and during the third trimester for high-risk mothers.

Spike in cases indicates lack of access to care and screenings, experts say

In 2018, half of newborn syphilis cases nationwide were linked to gaps in testing and treatment during prenatal care, according to the CDC. That year, roughly 9 in 10 newborn syphilis cases were in the South and West.

The South is home to swaths of rural communities lacking maternal health care. That only worsened during the COVID-19 pandemic as obstetric labor and delivery units shut down and access to prenatal care was strapped. Rural Western states that have large populations of Hispanic and Indigenous people also see maternal health care vanishing.

READ MORE:In rural America, maternal health care is vanishing. These moms are most at risk.

Studies have shown those with syphilis are more likely to experience poverty, mental health disorders and intimate partner violence, said  Dr. Irene Stafford, an associate professor at UTHealth McGovern Medical School. In Stafford’s Texas, 1 in 750 babies are born with congenital syphilis.

She said screening should be done in the third trimester and delivery to prevent missed opportunities for detection.

“This is a silent, quiet spread. We need to be screening in pregnancy,” she told USA TODAY. “If we just screened and treated in an appropriate fashion, we will be able to reduce that number of congenital syphilis cases."

“It's time to sound the alarm,” Stafford added.

Which states don't require syphilis screening? 

Along with Mississippi, the states that don't require syphilis screening during pregnancy are Hawaii, Iowa, Maine, Minnesota, New Hampshire, North Dakota, Wisconsin, according to the CDC.

Just 19 require third trimester screening, with five of those requiring it only if there is increased risk. Only 12 states require screening during delivery, with seven of those requiring it only if there is increased risk.

Racial disparities persist 

Katy Kozhimannil, director of the Rural Health Research Center at the University of Minnesota, said the disproportionate burden of congenital syphilis rates on Black babies shows a "confluence of reproductive health care" failures.

"It just magnifies what is already a tragic failure," she said. "We have all the tools that we need to effectively prevent and treat syphilis. It should not be rising. It should not be disproportionately affecting particular populations. When we see the burden of a preventable, treatable illness falling disproportionately on a group of people, that is a failure of the public health care system."

Underscoring the racial disparities in cases, syphilis is also a highly stigmatized disease with roots in medical injustice toward Black people, such as the Tuskegee syphilis study that withheld treatment from Black men for more than 40 years. 

“Unlike other sexually transmitted infections, syphilis bears the stigma of being interlinked with the legacy of Tuskegee, racism, distrust of government, and concerns about privacy or reporting bias. In particular, women with syphilis remain silent without advocacy and representation,” Stafford wrote in a Journal of the American Medical Association editorial.

Dig Deeper

Tuskegee Syphilis Study. How its repercussions are still felt today.

Native Americans given promise of health care. For rural moms, it's an empty one.

Pregnancy screening: Doctors should screen pregnant people for high blood pressure regularly, task force says

Inequities in maternal health care access are not new. They have deep roots in history.

Reach Nada Hassanein at nhassanein@usatoday.com or on Twitter @nhassanein_.