Babies Are Dying of Syphilis. It’s 100% Preventable. by Caroline Chen
The United States’ inability to curb a treatable sexually transmitted disease shows the failures of a cash-strapped public health system. Increasingly, newborns are paying the price.
…Yang carries a stack of cards issued by the Centers for Disease Control and Prevention that show what happens when the Treponema pallidum bacteria invades a patient’s body.
There’s a photo of an angry red sore on a penis. There’s one of a tongue, marred by mucus-lined lesions. And there’s one of a newborn baby, its belly, torso and thighs dotted in a rash, its mouth open, as if caught midcry.
It was because of the prospect of one such baby that Yang found herself walking through a homeless encampment on a blazing July day in Huron, California, an hour’s drive southwest of her office at the Fresno County Department of Public Health.
She was looking for a pregnant woman named Angelica, whose visit to a community clinic had triggered a report to the health department’s sexually transmitted disease program. Angelica had tested positive for syphilis.
If she was not treated, her baby could end up like the one in the picture or worse — there was a 40% chance the baby would die.
Yang knew, though, that if she helped Angelica get treated with three weekly shots of penicillin at least 30 days before she gave birth, it was likely that the infection would be wiped out and her baby would be born without any symptoms at all.
Every case of congenital syphilis, when a baby is born with the disease, is avoidable. Each is considered a “sentinel event,” a warning that the public health system is failing.
The alarms are now clamoring. In the United States, more than 129,800 syphilis cases were recorded in 2019, double the case count of five years prior. In the same time period, cases of congenital syphilis quadrupled: 1,870 babies were born with the disease; 128 died.
…Then, there are the miscarriages, the stillbirths and the inconsolable parents. Dr. Irene Stafford, an associate professor and maternal-fetal medicine specialist at UT Health in Houston, cannot forget a patient who came in at 36 weeks for a routine checkup, pregnant with her first child.
Stafford realized that there was no heartbeat. “She could see on my face that something was really wrong,” Stafford recalled. She had to let the patient know that syphilis had killed her baby. “She was hysterical, just bawling,” Stafford said.
“I’ve seen people’s families ripped apart and I’ve seen beautiful babies die.”
Fewer than 10% of patients who experience a stillbirth are tested for syphilis, suggesting that cases are underdiagnosed.
…Success starts with filling gaps across the health care system.
For almost a century, public health experts have advocated for testing pregnant patients more than once for syphilis in order to catch the infection.
But policies nationwide still don’t reflect this best practice. Six states have no prenatal screening requirement at all.
Even in states that require three tests, public health officials say that many physicians aren’t aware of the requirements. Stafford, the maternal-fetal medicine specialist in Houston, says she’s tired of hearing her own peers in medicine tell her, “Oh, syphilis is a problem?”
…A vaccine would be invaluable for preventing spread among people at high risk for reinfection. But there is none. Scientists only recently figured out how to grow the bacteria in the lab, prompting grants from the National Institutes of Health to fund research into a vaccine.
Dr. Justin Radolf, a researcher at the University of Connecticut School of Medicine, said he hopes his team will have a vaccine candidate by the end of its five-year grant. But it’ll likely take years more to find a manufacturer and run human trials.
…Public health agencies also need to recognize that many of the hurdles to getting pregnant people [WOMEN] treated involve access to care, economic stability, safe housing and transportation.