Eight North Carolina babies die from congenital syphilis

Eight North Carolina babies die from congenital syphilis

Jennifer Fernandez

Congenital syphilis caused six stillbirths and two newborn deaths in North Carolina last year, preliminary data shows.

Syphilis is a bacterial infection that is spread through sexual contact and is usually more common in men. However, in recent years, the prevalence among women (and therefore infants) has been on the rise.

“It changes the face of syphilis in general and infant syphilis in particular,” said Victoria Mobley, medical director for HIV/STIs in the Division of Public Health at the North Carolina Department of Health and Human Services.

Newborns may not show any signs of syphilis, but if left untreated, serious problems may develop within weeks or even years. Possible health problems include developmental delays, hearing loss, vision problems, skeletal abnormalities and neurological problems.

North Carolina health officials are alarmed by rising cases of congenital syphilis and are working on multiple fronts to reverse the trend.

The North Carolina Department of Health and Human Services has a website that provides information about syphilis, including a section on congenital syphilis. This is part of an effort to educate residents about sexually transmitted infections due to an increase in cases among women and newborns. Credit: NCDHHS

Learn more about congenital syphilis New in the country website.

Numbers keep rising

Syphilis was once a relatively common disease but almost disappeared after the introduction of penicillin as a treatment in 1940.

In 2000, incidence rates in the United States reached an all-time low, with just one case of congenital syphilis recorded in North Carolina more than a decade ago. By 2022, congenital cases had jumped to 53, with no deaths.

Mobley told members of the state Child Death Task Force last week that preliminary data showed there were at least 71 cases last year, including six stillbirths and two neonatal deaths. Neonatal death was defined as the death of a live-born infant within 28 days.

She said the data is preliminary because the state is still waiting for information about babies born late last year.

If a pregnant woman has syphilis, it may cause premature birth, low birth weight, stillbirth, or death of the newborn soon after birth.

Syphilis spreads easily. It first appears as sores on the genital area and later appears as a rough, red rash, according to the Centers for Disease Control and Prevention. There may be no symptoms in the later stages, but if left untreated, syphilis can cause damage to the brain, heart and other organs.

The CDC said in November that the increase in syphilis constitutes a national epidemic; they announced that by 2022, more than 3,700 babies in the United States will be born with syphilis, more than ten times the number a decade ago.

“The congenital syphilis crisis in the United States is soaring at a heartbreaking rate,” CDC Chief Medical Officer Debra Houry said at the time. “New action is needed to prevent more family tragedies. We call on health care providers, public health systems and communities to take additional steps to provide mothers and babies with the care they need.”

The CDC is asking health care providers to make some changes to help detect cases early or prevent them. Recommendations include starting syphilis treatment as early as possible after a positive rapid test and screening sexually active women and their partners in counties with high syphilis prevalence.

There is also a federal task force focused on lowering rates.

Influencing factors

As part of addressing the crisis, North Carolina health officials need to figure out what’s driving the rise in cases in the state.

Mobley told members of the Child Death Task Force last week that interviews with some mothers who had congenital syphilis in 2022 revealed three areas of concern.

Mothers reported:

  • There was no prenatal care or care was delayed.
  • Failure to screen for syphilis during pregnancy as required by state health rules.
  • Experienced treatment delays after diagnosis.

More than half of mothers with congenital syphilis give birth without documented prenatal care, Mobley said.

She said only 41 per cent of women who received prenatal care received appropriate tests. State law requires health care providers to test anyone who is pregnant for syphilis at the first prenatal visit, between 28 and 30 weeks of pregnancy, and at delivery.

For more than half of the mothers, treatment began within a week of diagnosis. About a quarter of the mothers took more than two weeks to start treatment.

“Certainly, the sooner you start treatment, the more likely you are to prevent infection or, if not prevent it, eradicate it in your unborn baby,” Mobley said.

The interviews help shed some light on some of the state’s responses to the crisis.

Effects of congenital syphilis:

Congenital syphilis is a highly contagious bacterial infection that is passed from the mother to her fetus in utero or to her newborn at birth.
It can cause:
• Miscarriage
• Stillbirth
• Premature birth
• Low birth weight
• Died soon after birth

Babies infected with syphilis at birth may develop:
• rash
• Jaundice (yellowing of the skin or eyes)
• Severe anemia (low red blood cell count)
• Bone deformation
• Enlargement of liver and spleen
• Meningitis (infection/inflammation of tissue surrounding the spinal cord and brain)
• Brain and nerve problems (including blindness or deafness)

Source: Centers for Disease Control and Prevention

What is NC doing?

Last October, North Carolina health leaders met with other health officials and insurance companies from across the Southeast to discuss ways to work together to reduce the number of congenital syphilis cases.

They agreed on a set of standards:

  • Women should be tested for syphilis at prenatal care, between 28 and 32 weeks, and at delivery.
  • Newborns should not be discharged from the hospital until the results of the mother’s delivery syphilis test are available.

In December, North Carolina launched a media campaign focusing on the importance of syphilis testing for sexually active people. Mobley said the campaign will expand over the next three months.

The state has also created a website that provides information about syphilis and resources such as testing sites.

Other efforts include reaching out to health care providers to encourage increased screening of pregnant women in all settings and increasing access to rapid tests for syphilis and HIV.

Mobley said the state is also working to increase reimbursement rates for bicillin, a penicillin product commonly used to treat syphilis, to encourage more sites to keep the product in stock.

“Congenital syphilis is a completely preventable infection with devastating consequences,” Shannon Dowler, North Carolina’s chief medical officer for Medicaid, said in a statement announcing the collaboration last month. “It’s time to address this problem in a different way.”

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