Syphilis and Congenital Syphilis Rise Sharply in the US, Causes Explained
Both syphilis and congenital syphilis have been rising over the decades at alarming rates.
“More than 10 times as many congenital syphilis cases were reported in 2022 … than in 2012,” the report authors wrote.
“I’ve seen ups and downs and syphilis cases over the years, but nothing in my lifetime compares it to what we’re going through right now,” Dr. Justin Radolf, who was not involved in the report but has over 40 years of infectious disease clinical experience, told The Epoch Times.
The Rise of Syphilis and Congenital Syphilis
Syphilis is a sexually transmitted disease caused by the Treponema pallidum bacterium.
Early stages of the disease manifest with mild and transient symptoms, but infection persists for many years if untreated, potentially leading to serious health problems.
Congenital syphilis is transmitted from an infected mother to her baby and can cause complications of stillbirth, infant death, loss of vision, and deafness in the baby if untreated.
“When there is an increase in the overall percentage of individuals infected with syphilis, this increase will inevitably trickle down into the population of pregnant women, thus affecting the rate of syphilis among newborns,” wrote Sharon Bond, PhD, a nurse-midwife with 35 years of clinical practice who has since retired from the Medical University of South Carolina, in an email to The Epoch Times.
Syphilis rates in the United States have been increasing since 2001. Between 2021 and 2022, congenital syphilis cases increased by 32 percent.
For decades, syphilis was most prevalent in men who have sex with men, teenagers, prostitutes, and people with many sexual partners.
“The increase in sexual contacts puts people at risk for getting infected,” Dr. Jeffrey Klausner, a clinical professor of medicine, infectious diseases, and population and public health sciences at the University of Southern California, wrote via email to The Epoch Times.
However, over the years, heterosexual syphilis rates have also increased, possibly due to an overlap between heterosexual couples and men who have sex with men, said Dr. Radolf, a professor of medicine and pediatrics at the University of Connecticut.
People with only one sexual partner are also at increasing risk of syphilis.
“Although there is a presumption that ‘sex with multiple partners’ is the dominant risk factor, studies have shown that almost half of women diagnosed did not have a risk factor of ‘multiple partners,’” Ms. Bond wrote.
“It could be the mother, but it could also be the father who is having all the sexual partners; that is a common scenario,” Dr. Radolf said. “Over the years, I’ve treated women who were sometimes elderly who had syphilis because they were infected probably by their husband and they didn’t know it and then developed some complication.”
Drug use can put a person at risk of syphilis as well, Dr. Klausner added, since people who use drugs may be willing to trade sex for drugs.
Studies have also investigated if the widespread use of contraceptive pills is associated with the rise in syphilis cases since, while these pills prevent pregnancy, they do not prevent sexually transmitted diseases. The link is still inconclusive.
Inadequate Treatment and Prenatal Care
The primary reason for the rise in congenital syphilis is low or inadequate access to prenatal care.
In 2022, lack of timely testing and adequate treatment contributed to almost 90 percent of the syphilis cases, and over half of the mothers who tested positive during their pregnancies did not receive adequate treatment.
“Inadequate treatment refers to: Did the mother start treatment at least 30 days before delivery, and did she complete the appropriate treatment for her clinical stage of syphilis,” said Dr. Emily Adhikari, assistant professor in the Department of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center.
Infections during the third trimester of pregnancy present the most significant risk, obstetrician Dr. Ameeta Singh, clinical professor at the University of Alberta, told The Epoch Times.
Yet not every primary care clinic may stock the antibiotic. In the United States, the only provider is Pfizer, and there has been a drug shortage.
There is also the chance that syphilis may be missed since most infected patients may have an asymptomatic, latent infection. Even with symptoms, doctors may miss it or mistake it for something else.
“Clinician awareness of the public health problem we are now facing is critical, and we are trying to spread the word,” Dr. Adhikari noted.
Silent and Easy to Miss
Syphilis is known as “the great imitator,” as it can present very similarly to a large variety of other diseases, which can sometimes complicate its diagnosis, especially in the later stages.
“In the old days, it was said if you know syphilis, you know medicine, because syphilis comes in so many different guises, clinically, at different stages,” Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center, told The Epoch Times.
Syphilis goes through four stages: primary, secondary, latent, and tertiary.
The primary stage occurs days after infection. A painless ulcer called a chancre appears at the genital, anal, or oral site of infection. Since it is painless and temporary, it may go unnoticed, or individuals may not seek medical attention.
The secondary stage occurs weeks to months after the chancre’s appearance. By this time, the bacteria have infiltrated the blood vessels, and symptoms are more systemic, manifesting as rashes, flu-like symptoms, weight loss, and hair loss. These may be misdiagnosed as other diseases, or, once again, patients may not seek medical treatment as these symptoms are transient.
The infection then typically becomes latent or hidden. The patient has no symptoms during this time, but the bacteria are still present. This stage can last many years.
Tertiary syphilis is rarer and tends to occur many years after infection, when the bacteria damage internal organs, including the heart, brain, nerves, bones, and joints.
Primary infections during pregnancy pose the highest risk of congenital syphilis. The risk of transmission of maternal primary or secondary syphilis is 60 percent to 80 percent, whereas the risk of transmission of latent or tertiary syphilis is about 20 percent.
Infected pregnant mothers do not present with any different symptoms than an average infected person, and most fetuses who are infected during pregnancy are asymptomatic both in the womb and after birth.
The disease can be hard to diagnose unless a doctor specifically tests for syphilis using a blood test that checks for antibodies. The same applies to congenital syphilis.
High Risk of Harming Babies
Around one-third of congenital syphilis cases result in a stillbirth or infant death. Another 40 percent result in an infected child, with only 20 percent of mothers giving birth to a live and healthy baby.
Untreated babies who are particularly sick may develop symptoms in the womb in the second or third trimester, which can be detected through ultrasound. This is why doctors say prenatal screening is essential.
“The sickest babies are those that have signs on the ultrasound that may include a big placenta and an enlarged liver,” Dr. Adhikari said. “We may see fluid in the abdomen or around the heart, and we may see signs of fetal anemia on the ultrasound. Those are all concerning signs.”
Some common symptoms of congenital syphilis include a prominent forehead, abnormal saddle nose, prominent jawbone, and bowing of the shin.
Children can also develop abnormally-formed notched teeth and intellectual disability. Late stages of congenital syphilis include hearing and vision loss, Drs. Cecilia Di Pentima and Ruben Vaidya, a professor of pediatrics and an associate professor of pediatrics at the University of Massachusetts Chan Medical School-Baystate, respectively, wrote in a joint statement to The Epoch Times.
Yet most infected babies would not show symptoms or physical abnormalities at birth, and their illness may be missed, the two added.
The babies are innocent victims, and “they’re the ones who pay the price,” Dr. Radolf said. For asymptomatic babies, “we don’t know the long-term consequences.”
What’s Next?
Dr. Radolf and his team have been working on better diagnostics and a vaccine to prevent and treat syphilis.
While tests can directly verify the presence of syphilis in adults and pregnant women, the most common tests used in the clinical setting are blood tests that often require subsequent testing due to interpretive findings.
The primary diagnostic technique uses an antibody requiring an algorithm, which is “a multi-step process” that increases the potential for misinterpretation or missed diagnoses, Dr. Adhikari said.
Current diagnostic techniques for congenital syphilis may also miss infected babies if their antibody levels against syphilis do not meet certain levels.
“The problem is that the maternal antibodies can readily cross the placental barrier, complicating the classic strategy we use for diagnosing syphilis,” Kelly Hawley, senior research scientist at Connecticut Children’s and assistant professor at the University of Connecticut, told The Epoch Times.
Unlike most other bacteria, Treponema pallidum is highly fragile. It is challenging to obtain a sample because it replicates slowly in the body, and it requires special conditions for laboratory culturing. This has hindered research into more reliable and accurate diagnostics and vaccines for syphilis. It was only recently that laboratory techniques were developed to culture and study these bacterial specimens.
“When I was just getting started, it [syphilis] was a virtual black box,” Dr. Radolf said. “And it took us 30 years to figure that out.”
Source: Epoch Times
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