The U.S. Centers for Disease Prevention delivered a one-two punch of bad news recently. The first bad news is that the number of cases of three sexually transmitted diseases—chlamydia, gonorrhea, and syphilis—are rising at an alarming rate. But worse, the incidence of congenital syphilis, which occurs when a mother who has untreated syphilis passes it to her child during her pregnancy, is rising as well.
Syphilis is one of those diseases that everyone thought had been beaten. It can be treated and cured with antibiotics, and had become relatively rare by the 1990s, when there were 2.1 cases of syphilis per 100,000 people in the United States. But the rate started climbing after the turn of the millennium. The CDC says that the rate of syphilis has tripled to 6.3 cases per 100,000 cases in 2014. Some areas of the country have it worse than others. In Oregon, the syphilis rate increased by more than 1,000% from 2007 to 2014.
The number of diagnosed cases is known because syphilis is what is called a reportable disease, which means doctors and other health professionals must report each case they diagnose to public health officials. But many people with syphilis may not get diagnosed because their symptoms are mild and they don’t go to the doctor. The first symptoms are painless sores on the genitals or in the mouth. Secondary symptoms, which occur later if the infection is not treated, include a rash, fever, headache, and sore throat. Then the symptoms disappear, but the person can still infect other people. If syphilis is untreated for a long time, it can reappear years later and cause brain and nerve damage, blindness, and even death.
When a pregnant woman has untreated syphilis, her baby can be born with congenital syphilis. Congenital syphilis can cause serious illness in babies and can also cause miscarriage and stillbirth. Up to 40% of babies with congenital syphilis may be stillborn or born so ill that they die in early infancy. Babies who survive may have problems that can include an enlarged liver and spleen, nerve damage, blindness or vision problems, deafness, severe anemia, and deformed bones. Many babies with congenital syphilis are born with what is called syphilitic rash.
Not every baby born with syphilis has symptoms that are immediately recognized at birth. Some problems develop later during the baby’s infancy.
The rate of congenital syphilis is low. There were 458 cases reported in 2014 or 11.6 cases per 100,000 live births. But these low numbers are still a problem because each of these cases of congenital syphilis was completely preventable had the infection been diagnosed in the mother during her pregnancy. A CDC report noted that one case of congenital syphilis means that there were many missed opportunities for prevention by the public health and healthcare systems.
Syphilis can be treated with antibiotics even during pregnancy. Babies who are born with congenital syphilis must be treated as soon as possible after birth.
The CDC recommends that all women should be tested for syphilis during their first prenatal care visit. Women who live in areas where there is a high incidence of syphilis should be tested again later in the pregnancy.