Alarming surge in medieval disease in babies as health system dubbed a failure

12 November 2023 , 08:00

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A dangerous spike in syphilis cases among babies has the CDC concerned — and it's blaming the US healthcare system (Image: Getty Images)

More and more American babies are being born with a medieval-era disease every year, with cases "increasing at an alarming rate." The Centers for Disease Control and Prevention (CDC) are now calling out a "failure" of the US's health system after 282 infants died in 2022.

The worst part of it all is that the disease in question — syphilis — can be easily prevented and treated if screenings are conducted regularly and treatment begins early enough. At least 248 of those 282 babies, or 88%, need not have succumbed to the disease, the CDC said in a groundbreaking new report.

Over 3,700 babies were born with syphilis last year, which is more than 10 times the amount born with the deadly sexually transmitted infection (STI) in 2012. It also represents a 31.7% increase from the just over 2,800 cases recorded in 2021. In contrast, there were 335 cases in 2012.

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282 infants died of syphilis in 2022, and the CDC said at least 88% of those deaths could have been prevented (Getty Images)

But what is congenital syphilis, and why is it so dangerous? In short, the disease is deadly when left untreated, and even in cases in which the infant survives, there can be long-term health complications resulting from it.

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"Congenital syphilis can lead to stillbirth, miscarriage or neonatal death, and surviving infants who are not adequately treated might develop blindness, deafness, developmental delay or skeletal abnormalities," the CDC wrote in its report. The mothers can also die in childbirth or from complications relating to the disease itself — congenital syphilis specifically refers to syphilis that is passed from the mother to the child.

The cause of the spike in cases, the CDC says, is related to a corresponding spike in reproductive-age women. Cases in women aged 15 to 44 rose by 676% from 2012 to 2021, from 2.1 cases per 100,000 people to 16.3 per 100,000. That includes primary and secondary cases.

Many of the cases of congenital syphilis have resulted from a lack of testing or adequate care for the disease (Getty Images)

The deaths specifically are related to a lack of proper screening and prenatal care, the CDC added. The organisation created a list of six "potential missed prevention opportunities among congenital syphilis-associated pregnancies:

1. Undocumented or untimely testing
2. Late identification of seroconversion (the presence of antibodies) in the blood during pregnancy
3. Lack of or undocumented treatment
4. Inadequate treatment
5. Evidence of congenital syphilis despite documentation of treatment
6. Insufficient data to identify syphilis

"Congenital syphilis is preventable through timely testing and adequate treatment of syphilis during pregnancy," the CDC wrote. "To reduce perinatal transmission, CDC recommends screening for syphilis during pregnancy at the first prenatal care visit. Where access to prenatal care is not optimal, screening and treatment (if indicated) should be performed as soon as pregnancy is identified."

The CDC also noted numerous racial and geographic disparities present in the dataset, noting that people of certain demographics who live in certain areas of the US were more likely to contract the disease or pass it on to their babies.

Racial and geographic disparities in the CDC's datasets are showing that certain demographics in certain areas are more prone to congenital syphilis cases (Getty Images)

Breaking it down, untimely testing or a complete lack of testing altogether resulted in half the cases in the West and Northeast regions of the US and the largest portion of cases in the Midwest. The South, however, was impacted most by lack of adequate treatment.

Similarly, untimely or a lack of testing accounted for the majority of cases in Native Americans or Alaska Natives, Native Hawaiians, Pacific Islanders and white people. Black and Hispanic Americans, however, were most impacted by a lack of adequate treatment.

To prevent passing the disease on, the organisation recommends testing at 28 weeks and at delivery, especially for those who live in communities with high rates of the disease, those at high risk for acquiring it such as through substance use or a new partner during pregnancy and those who haven't been tested before.

The CDC recommends pregnant mothers get regularly screened and tested for syphilis to avoid congenital syphilis and its complications (Getty Images/iStockphoto)

"Appropriate screening for syphilis during pregnancy, as well as screening of sexually active persons when appropriate, has been shown to prevent syphilis morbidity," the organisation wrote. "Identifying missed opportunities (e.g., lack of screening and inadequate treatment) to prevent congenital syphilis and treat syphilis during pregnancy is critical to understanding drivers of the current congenital syphilis surge and to better direct public health interventions."

The signs of syphilis include sores and rashes, which might eventually disappear, but if the disease is left untreated, it can spread quickly to internal organs and damage them beyond repair, leading to death. That usually happens after the bacteria is left to fester for decades in the body.

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It generally spreads through sexual contact, but it can also be acquired by touching toilet seats, doorknobs, sharing clothing and utensils and bathing in baths, hot tubs or swimming pools that have been infected.

The only treatment for syphilis deemed safe enough to use during pregnancy is benzathine penicillin G, which is administered via injections, either a singular one or a series of three spaced a few days apart.

But overall, the prevalence of syphilis in the first place and its rise is a cause for concern for the CDC, and it blames the healthcare system in the US, especially as two in five (40%) of women who gave birth to infants with congenital syphilis did not receive any form of prenatal care at all.

"Increasing rates of syphilis among babies reflect a failure of the US health system," the CDC concluded. "Too many people are not being tested and treated early enough during pregnancy."

Jeremiah Hassel