A newly pregnant woman goes to the doctor for prenatal care and gets tested for sexually transmitted diseases, as required by law in many states. The results are negative, but weeks later she shows up in the emergency room with a rash and is diagnosed with syphilis, which the doctors didn’t even think to test for.
Now the unborn baby also has the disease, referred to as congenital syphilis, and a month and a half later, the patient delivers a stillborn.
Case studies like this one are on the rise, according to the Centers for Disease Control. The Sexually Transmitted Disease Surveillance Report, released Tuesday, found that congenital syphilis, which is passed down from an infected mother to her fetus, has more than doubled since 2013 to hit a 20-year high.
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In 2013, 362 cases were reported in the United States; by 2017, that figured had jumped to 918 cases in 37 states, concentrated in the West and the South. Louisiana has the highest rate per capita, with 59 cases reported last year, while California has the highest rates overall, with 281 cases reported in 2017, followed by Texas’s 176.
Syphilis is easily treated with antibiotics, but if left untreated, pregnant women are about 80 percent likely to pass on syphilis to their babies. And the progression of the disease is devastating: sores turn into painful rashes that can cause damage to major internal organs like the brain and heart even years after initial exposure.
Last month, the CDC reported that overall rates of syphilis had spiked 76 percent, from 17,375 cases in 2016 to 30,644 cases in 2017. But unlike chlamydia and gonorrhea, which are also seeing sharp rises in incidences, syphilis is not rising because of antibiotic resistance; it’s cured by penicillin, attacks the bacteria responsible for the disease, T. pallidum.
But syphilis isn’t on the radar for some doctors treating women of reproductive age, according to Gail Bolan, the director of the division of STD prevention at the CDC.
“Congenital syphilis is a needless tragedy,” she told The Daily Beast. “It is completely preventable. These cases are showing us that we are missing opportunities to screen and treat pregnant women with syphilis and to prevent any of the disease in the unborn child.”
Congenital syphilis is a painful and destructive infection, often leading to miscarriages, premature births, and stillbirths. If a baby survives, a range of physical deformities can occur: enlarged liver and spleen, anemia, jaundice, body rashes, damage to the brain and heart and eyes.
"If the unborn child has such a severe infection already they're not likely to survive at all even with treatment,” Bolan said.
Bolan said the CDC’s focus is on women who acquire syphilis during pregnancy because it’s especially dangerous when the exposure is in utero.
Most states require women to be tested for STDs on her first prenatal visit. But Bolan said that many women are not receiving timely prenatal care that would improve the chances of catching and treating syphilis.
"Certainly, we know that lack of prenatal care is one of the most significant risk factors for a woman having a baby with congenital syphilis for obvious reasons," Bolan said. "But we're also seeing a mix of factors [contributing to the rise of congenital syphilis]: poverty, substance use disorders, unstable housing, incarceration, and mistrust of the healthcare system."
And today's doctors may not have any idea what syphilis looks like because until recently, it had been disappearing; Bolan recalled a medical school professor in the 1970s telling her class, "Syphilis is a very interesting, historical disease. You'll never see a case in your career."
"I've been living with it in my career for many years now," Bolan said. "Unfortunately, it's common in medicine if things are uncommon, the skill set for providers declines. If you haven't seen it for a while, it's just not on your radar."
Its symptoms–fevers and rashes–also mimic other infectious diseases, paving the way for misdiagnosis. It’s also not uncommon for initial tests to result in false negatives.
To guard against that, Bolan suggests that women living in an area where syphilis or who have risk factors should get a second test at the beginning of the third trimester to make certain they are not infected.
"I'd like to say that one case of congenital syphilis is one case too many," she said. "We have the tools to prevent this ancient congenital infection but we need to make sure we're applying our tools and that women are getting the care they deserve.
"Protecting every baby starts by protecting every mother."
