Cases of congenital syphilis, an infection passed by a mother to her child during pregnancy, rose by 32% in the United States between 2020 and 2021, with more than 2,000 cases reported in 2021 alone, according to the Centers for Disease Control and Prevention (CDC).
The problem is not unique to the United States. Other middle- and high-income countries have seen sharp increases in cases after years of relative control. Worldwide, congenital syphilis continues to be a significant public health problem, despite a 2007 global health initiative by the World Health Organization to eliminate mother-to-child transmission by 2030.
The health consequences of sexually transmitted infections (STIs) in general, and of congenital syphilis in particular, are serious and expensive to treat. STIs can lead to chronic pain, infertility, fetal abnormalities, and neonatal death.
Factors contributing to the rise of congenital syphilis in the United States include poor access to health care, unemployment, homelessness, and substance abuse. Racial disparities are also apparent; the rate of reported cases of congenital syphilis among Hispanic, American Indian/Alaskan Native, and Black populations is three to six times higher than among White populations. Regional variations in diagnosis and treatment have also played a role, according to the CDC. In the South, infected pregnant women weren't adequately treated despite timely diagnosis of infection. In the West, patients went undiagnosed due to lack of prenatal care. And, in the Northeast, seroconversion was detected too late in pregnancy to prevent transmission. Fragmented prevention programs and inadequate federal and state funding add to the problem.
To combat this fragmentation and improve diagnosis and treatment, the U.S. Department of Health and Human Services (HHS) has developed a five-year strategic plan with the goal of reversing the upward trend of cases by 2030. Among several strategies, the HHS plan calls for prioritizing testing and treatment of the populations most at risk: adolescents and young adults, men who have sex with men, and pregnant women. It also aims to reduce racial disparities in prevention and treatment and integrate STI testing and treatment into relevant public health programs, such as those focused on substance use disorders.
An important role for nurses in this effort is counseling pregnant women to be tested for syphilis-the STI most dangerous to the developing fetus-as soon as they know they are pregnant. Congenital transmission is preventable with prompt antibiotic treatment of the infected mother. Women at risk should also be counseled to reduce the chances of STI exposure by using condoms during sexual activity. Read the latest CDC guidelines for preventing, detecting, and treating congenital syphilis at http://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm.-Gail M. Pfeifer, MA, RN