The Problem:
Rates of congenital syphilis, a sexually transmitted disease passed on from an infected mother to her child during pregnancy, have increased drastically across the United States over the past couple of years. In 2012, the country reached a low rate of 8.4 cases per 100,000 live births; however, this rate increased by 38% between 2012 and 2014 (1). The increase in congenital syphilis between 2012 and 2014 also coincided with a 22% increase in primary and secondary syphilis among females (1).
This increase in congenital syphilis has been a particular concern for the state of California, as it has become the state with the second highest rate of congenital syphilis in the nation, behind Louisiana (5). The number of reported congenital syphilis cases in California has increased more than threefold from 40 cases in 2011 to 141 cases in 2015 (2).
This increase in congenital syphilis is part of an overall increase in syphilis across the state. From 2011 to 2016, there was an alarming 412% increase in syphilis cases in Orange County, California (3). Similar trends of an increase in syphilis and other sexually transmitted diseases (STDs) have been noted in many major counties across California (3). STD rates in California in 2015 were the highest in 25 years (4). While the data has yet to come out for 2016, an article on CNN states that 2016 preliminary data for California shows a continuing 21 percent increase in syphilis in women and a four percent increase in congenital syphilis (5).
The majority of the congenital syphilis cases by 2015 were reported in the Central Valley and Los Angeles regions of California (8). The two California counties with the most cases of congenital syphilis today are Kern County and Fresno County (5). Nearly half of the reported congenital syphilis cases in 2015 were from these two counties (5). What is particularly concerning is the number of congenital syphilis cases in Kern County, which is 555 percent higher than the rest of California (9). This spike in both rates of syphilis and congenital syphilis highlights a significant public health crisis in the state of California.
What is Syphilis?
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum and is passed on from person-to-person via direct contact with a syphilitic sore or “chancre” (7). Transmission can occur through vaginal, anal, or oral sex in which there is direct contact with a syphilitic sore (7).
The Stages of Syphilis in Adults
Primary Stage
This is the first stage of syphilis in which a single or multiple sore appears at the site of infection (7). The sore is usually firm, round, and painless and can easily go unnoticed (7). These sores eventually heal regardless of whether the person receives treatment but without treatment for syphilis, the person is in danger of their infection progressing to the next stage.
Secondary Stage
At this stage of syphilis, a skin rash/sores appear on multiple areas of the body, swollen lymph nodes, and a fever occur (7). These symptoms, like the symptoms in primary stage, will heal regardless of whether the person receives treatment but will progress to the next stage of syphilis is left untreated (7).
Latent Stage
During this stage, there are no visible signs and symptoms of syphilis (7). Early latent syphilis is latent syphilis in which the infection occurred within the past 12 months (7). Late latent syphilis is latent syphilis in which the infection occurred more than 12 months ago (7). Latent syphilis can occur for years (7). As with the other previous stages, even though there are no symptoms in this stage, syphilis will continue to reside in the body without adequate treatment (7).
Tertiary Syphilis
A rare form of syphilis is tertiary syphilis, which can develop if the syphilis infection is left untreated and can be fatal (7). It can occur 10-30 years after initial infection (7). Tertiary syphilis can affect different organs in the body including the brain, heart, blood vessels, eyes, liver, joints, and bones (7). The symptoms of tertiary syphilis differ depending on which organ is affected (7).
Neurosyphilis and Ocular Syphilis
Syphilis that infects the nervous system is called neurosyphilis, which can cause paralysis (7). Syphilis that infects the eye structure is called ocular syphilis, which can cause blinding (7). Both neurosyphilis and ocular syphilis can occur at any stage (7).
Treatment for Adult Syphilis
Syphilis can be diagnosed through blood tests (7). It is treatable through an antibiotic called penicillin. Recommendations for different types of penicillin and dosages depend on what stage and severity of syphilis (7).
What is Congenital Syphilis?
Congenital syphilis occurs when a mother infected with syphilis transfers the disease to her unborn child during pregnancy (6). Congenital syphilis can be prevented through adequate and timely prenatal care (1). Pregnant mothers with syphilis can be treated using Bicillin, which is the only recommended antibiotic for infected mothers (11). However, there is a current shortage of Bicillin so it is recommended to take preventive measures to prevent from acquiring syphilis at all (11).
How does Congenital Syphilis affect the baby?
Congenital syphilis infection can lead to miscarriage, stillbirth, prematurity, low birth weight, or death shortly after birth (6). The extremity to which congenital syphilis affects the baby depends on how long the mother has had syphilis and if and when they received treatment (6). Up to 40% of babies born to women with untreated syphilis may be stillborn or die as a newborn from the congenital syphilis (6). Babies who are born with congenital syphilis can suffer from deformed bones, anemia, enlarged liver or spleen, jaundice, blindness, deafness, brain and nerve problems, meningitis, and skin rash (6). It is possible for babies to have congenital syphilis and present no symptoms, which is why it is important for babies to get tested at birth to determine whether or not they have congenital syphilis (6). If the baby is born with congenital syphilis, the baby is able to receive treatment for it but it must occur immediately or serious health complications can develop (6). The treatment involves antibiotics and depending on the severity, the baby may need to be hospitalized for up to ten days while receiving treatment (6). Congenital syphilis is completely preventable through adequate prenatal care and timely and effective treatment (8).
Why are we seeing particularly high rates of congenital syphilis in California?
Syphilis, a disease that was thought to be almost eradicated in 2000, is alarming many health officials with its recent increase (5). There are many reasons as to why there have been spikes in the syphilis and congenital syphilis rates. One reason is that many women who give birth to babies with congenital syphilis, generally do not receive adequate prenatal care. These women may be unaware of their infection, or receive prenatal care too late for timely and effective treatment to take place (1). Another reason, according to the Center for Disease Control, could be the state and local budget cuts for STD programs causing a decrease in access to services for those who need it (5).
For Fresno County, a region with one of the highest rates of congenital syphilis, one major factor in the spike of cases has been increased drug usage (10). According to the county’s health officer, Dr. Ken Bird, the major issue is methamphetamine users because they tend to have multiple sexual partners and to not use condoms (10). Another theory, pointed out by the Fresno county health officials, could be in part due to social media, presenting an easy means to acquire multiple sexual partners (10).
What is currently being done to address this public health issue?
California has enacted a few different approaches to tackling this increase in syphilis and congenital syphilis. Kern County has implemented a new sexual education curriculum in its high schools to hopefully reduce the rate of STDs (9). Fresno County has asked for help from the Center for Disease Control and has received funding to help pay for Bicillin, the treatment for recommended for infected mothers (10).
Even though California is taking some actions to address this epidemic, much more needs to be done. This spike of cases indicates a failure on the public health system. More campaigns need to be implemented in order to raise awareness to encourage people to get tested and prevent further spread of the disease. The most important things individuals can do is to know their risk and get tested, refrain from engaging in unprotected sex, and limit the number of sexual partners. As for pregnant women, it is recommended that they seek prenatal care and get tested twice for syphilis throughout their pregnancy. Hopefully, with California’s efforts, we will start to see a decline in the alarmingly high rates of congenital syphilis.
References:
1.https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a3.htm
2.https://www.cdc.gov/std/stats15/tables/41.htm
4.http://www.latimes.com/local/lanow/la-me-ln-std-rates-20161025-snap-story.html
5.http://www.cnn.com/2017/03/01/health/syphilis-newborns-partner/
6.https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm
7.https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm
9.http://bakersfieldnow.com/news/local/khsd-unanimously-approves-new-sex-ed-policy
10.http://www.fresnobee.com/news/local/article110375297.html
11.https://www.cdc.gov/std/treatment/drugnotices/bicillinshortage.htm
