The New York State Department of Health (NYDOH) is warning about the risks of congenital syphilis after three infant deaths related to the disease have been reported in the state so far this year.
The deaths occurred outside of New York City and are part of "a concerning rise" in congenital syphilis cases in the state and across the nation, according to the NYDOH.
Cases of congenital syphilis have been rising nationwide in recent years, according to data from the Centers for Disease Control and Prevention (CDC). In 2023, there were more than 3,800 cases reported, a 106% increase from 2019 and the highest annual case count on record since 1994.
MORE: Newborn syphilis cases at 'dire' levels as analysis shows tenfold increase in last decade: CDC
Public health experts told ABC News that congenital syphilis is largely preventable and, when left untreated, it can be dangerous, or even deadly.
"What's so devastating is that [congenital syphilis] is very preventable," Dr. Elizabeth Partridge, associate clinical professor of pediatric infectious disease at UC Davis Children's Hospital, told ABC News. "It's an epidemic of congenital syphilis and infections in women of childbearing age."
What is congenital syphilis?
Syphilis is a common sexually transmitted infection (STI). It starts as a painless sore where the infection entered the body.
This infection is easily treated with an antibiotic when caught early. If left untreated, it often progresses, over weeks or months, to a worsening rash that may be accompanied by symptoms such as fever, muscle aches, headache and fatigue, according to the CDC.
Symptoms can resolve on their own over time but without treatment, syphilis enters a "latent stage," or asymptomatic stage, that can last for years and may progress further to a "tertiary stage" that can impact multiple organs in the body.
Congenital syphilis occurs when a pregnant person with untreated syphilis passes the infection to their baby either during pregnancy or at birth. It can be treated with antibiotics and it's best to treat as soon as possible to prevent more severe complications of the disease.
The CDC recommends that all pregnant people get tested for syphilis at their first health care visit after learning they are pregnant. Some places with higher rates of this infection may recommend additional screening throughout pregnancy and at birth.
Partridge said women of childbearing age who have barriers to prenatal care are at greater risk because they may miss out on syphilis screening.
"I see a lot of times that moms don't get those full screenings done, they don't have access to that kind of prenatal care. And that, to me, is just tragic because if moms can get screened, then they can get treated," Partridge said.
Why can it be so dangerous?
Congenital syphilis can lead to miscarriage, stillbirth, low birth weight, prematurity or infant death soon after birth, according to the CDC.
Babies born with this disease can have deformed bones, low blood counts, jaundice and organ dysfunction, including problems with the brain and nervous system or enlarged liver and spleen. Partridge says common symptoms of congenital syphilis are known but many aren't obvious at birth.
MORE: Mississippi sees 10-fold increase in babies born with syphilis since 2016: Report
"I think up to 70% of babies who may meet the case definition for congenital syphilis are actually asymptomatic, which makes diagnosing it quite challenging," Partridge said.
Without treatment, babies who are asymptomatic at birth can begin to show signs of the disease weeks, months or years later.
"If they're undetected, if the infants are left untreated, they go on to develop what we call later sequelae, and that's when you see deafness, blindness, developmental delay, the quite devastating illness," Partridge said.
Why is congenital syphilis on the rise?
Dr. James McDonald, commissioner of the NYDOH, told ABC News that the three newborn deaths from syphilis are concerning because it's uncommon to see infant deaths from the condition.
McDonald said that New York State has seen 21 cases of congenital syphilis so far this year, compared to 36 cases all of last year.
"Keep in mind, these may sound like big numbers, but for upstate New York, they are big numbers," he said. "What concerns me, though, is it should be zero."
Kristin Wall, an associate professor of epidemiology at Emory University's Rollins School of Public Health, told ABC News the U.S. has seen a steady rise in congenital syphilis cases over the last 10 years. This is despite decreases in cases of chlamydia and gonorrhea, according to CDC data.
She said that there are racial/ethnic disparities when it comes to the populations experiencing the highest rates of congenital syphilis.
"So the highest rates we're seeing are in Native Americans, American Indians, Alaska Natives, Hispanic populations and Black populations," Wall said. "And I think it's really important to think about access to care barriers as one of the big reasons that we're seeing these increasing rates in certain populations."
Barriers can include lack of insurance or lack of transportation as well as mistrust of the medical system due to past prejudices, according to Wall.
How to drive down rates of congenital syphilis
Wall said half of cases are occurring among patients who are receiving prenatal care, but are missing timely and appropriate treatment, and the other half are occurring in people who are not engaged in care at all.
For those who are receiving prenatal care, Wall said there is a push to implement point-of-care testing, meaning testing outside of a traditional clinical laboratory, often at the patient's bedside.
Delays in waiting for laboratory test results to come back and then trying to recontact the patient can lead to delays in delivering a diagnosis or administering care, Wall said.
MORE: FDA authorizes 1st over-the-counter, at-home test for syphilis
"A very exciting development to address that is the point of care syphilis testing, where you have a patient right in front of you, you're able to administer that test, get test results in 20, 30 minutes, and administer directly observed treatment right there, without sending, you know, your patient away," she said.
For the patients who are not receiving care, Wall said it's important to work with community partners to enter underserved communities and spread awareness, as well as make sure men and women are getting tested to prevent cases from occurring in the first place.
McDonald said that as part of an effort to eliminate syphilis from pregnancy, New York State requires three syphilis screenings for pregnant people.
"When someone's pregnant, they're supposed to be checked for syphilis three times, one when they have their first visit, the second time around the third trimester, and then the third time is where they give birth," he said. "Part of our message to health care providers is: ensure people are being screened appropriately."
He also encouraged people to practice safe sex to prevent the spread of STIs, including the use of condoms.
Jade A. Cobern, MD, MPH, is board-certified in pediatrics and general preventive medicine, and is a medical fellow of the ABC News Medical Unit.
Comments