The most alarming concerns center around the congenital syphilis epidemic, signaling an urgent need for swift innovation and collaboration from all STI prevention partners.
The CDC data, released this week as part of its 2022 STI Surveillance Report, shows more than 2.5 million documented cases of chlamydia, gonorrhea and syphilis in the United States. Chlamydia and gonorrhea are the two most frequently occurring forms of STIs, accounting for more than 90 percent of the 2022 cases.
In addition to the syphilis epidemic worsening, reported gonorrhea cases declined for the first time in at least a decade while reported chlamydia cases were level.
Cases of primary and secondary syphilis—the most infectious stages of the disease—increased 10 percent in 2022 alone and 68 percent since 2018.
Steady growth in primary and secondary syphilis among women fuels the congenital syphilis epidemic, threatening the health of babies. Building on a decade of increases, reported congenital syphilis cases increased 31 percent in just one year, from 2021-2022. Nearly every state reported having at least one congenital syphilis case. Some states are feeling the impact more than others – Texas, California, Arizona, Florida, and Louisiana represented 57 percent of all reported congenital syphilis cases.
Racial and ethnic minorities continue to be disproportionately affected. The highest number of cases occurred among those who are Black or African American, Hispanic and Latino, and White. American Indian or Alaska Native people experienced the highest rate of congenital syphilis—for every 155 births in 2022, there was one congenital syphilis case. Black or African American people experienced about 30 percent of congenital syphilis cases in 2022.
The number of babies born with syphilis in the United States is increasing at an alarming rate. Increased and innovative syphilis testing and treatment can reduce the number of babies born with syphilis and improve health during pregnancy. There were more than 3,700 babies born with syphilis in 2022, over 10 times the number reported in 2012. These increases reflect overall increases in syphilis among women of reproductive age. People can experience illness and pass syphilis to their babies during pregnancy. Miscarriage, stillbirth, severe lifelong health problems, and even newborn death can result from syphilis infection during pregnancy. In 2022, there were 231 stillbirths and 51 infant deaths. Increasing rates of syphilis among babies reflect a failure of the U.S. health system. Testing for and treating syphilis during pregnancy more than 30 days before delivery can prevent this infection in newborns. CDC Vital Signs
There is a crisis of congenital syphilis in high-income countries worldwide, with rising cases disproportionately affecting vulnerable populations. It is unacceptable that we are seeing this trend in countries that have widespread availability of penicillin and ample resources for education, testing, and treatment. The consequences of congenital syphilis are both varied and devastating. In cases where syphilis in pregnancy goes untreated, 67% of women will have an adverse outcome of pregnancy, including 26% who will have a fetal loss or stillbirth. Diagnosis can be difficult given that neonates are often asymptomatic at birth. In addition to specific syphilis testing, investigations for an infant at risk of CS should include ophthalmology examination, chest and long bone radiographs, assessment of cerebrospinal fluid (CSF), full blood count (FBC), and blood chemistry. Research and Reports in Neonatology
In 2007, the World Health Organization (WHO) launched a global health initiative for the elimination of mother-to-child transmission (MTCT) of syphilis. This review summarizes the global status of MTCT of syphilis and concludes that this condition remains a significant issue worldwide. There are large variations in case rates by region, with the highest numbers of cases in the African and Eastern Mediterranean regions, where there are also the least data available. Although the general trend is of decreasing rates over time, there are concerning indications of consistently increasing congenital syphilis cases in some areas, particularly in areas which have previously had very low case numbers. Clinical Microbiology Reviews
European data on this congenital infection is lacking. This retrospective cohort study was conducted at the Perinatal and Pediatric Infectious Diseases Units of the Federico II University of Naples, enrolling all newborns and children referred from January 2010 to June 2022 exposed to Treponema pallidum in utero and/or congenitally infected. A total of 323 patients were included in the analysis. Twenty (6.2%) received a diagnosis of confirmed congenital syphilis (CS) and one died. Fifteen CS cases had typical clinical features. Mothers of CS cases were younger (25 ± 7.2 vs 29.9 ± 6 years), had less previous pregnancies (0.64 vs 1.11), and received a diagnosis of syphilis at a later stage of pregnancy (86% vs 20%, from third trimester or later on). Appropriate maternal therapy was protective against vertical transmission (− 1.2; − 1.4, − 1 95% CI). Paternal syphilis status was known in 36% of cases. European Journal of Pediatrics