From Dormant to Deadly: Why we should all be worried about skyrocketing congenital syphilis cases
Houston, we have a problem. Cases of congenital syphilis in the United States are on the rise and if you’re not concerned, you should be. Stat News reports that in 2019, cases of congenital Syphilis rose 300% from 623 to 1,870, having increased 261% over five years from 2013 to 2018. And in Los Angeles County alone, The L.A. Times reported that in Los Angeles congenital syphilis cases skyrocketed from 44 in 2017 to 113 in 2020.
“We bear witness yet again to another and unforgivable increase in congenital syphilis cases in Los Angeles — an avoidable, heart-rending tragedy that Los Angeles County has, essentially, done nothing about for years and years,” said AIDS Healthcare Foundation President Michael Weinstein.
Rising congenital syphilis cases represent “a catastrophic failure of the US healthcare system.” Why are these numbers significant? Because congenital syphilis rates are the highest they’ve been since 1995, usurping mother-to-child HIV transmissions at the height of the AIDS crisis. The Centers for Disease Control and Prevention reports that in 2019, the national rate of congenital syphilis cases was 48.5 per 100,000 live births. That is 41.4% higher than in 2018 and 291.1% higher than in 2015.
Dr. Ina Park of UCSF, caught onto this devastating trend in 2019 when she noticed requests for Congenital Syphilis consultations at the California Prevention Training Center rose to the hundreds but was a rare request in previous years.
These findings are concerning, to say the least, and they expose a lack of STD screening for expectant mothers. But to properly illustrate the severity of the issue we must understand the damage that congenital syphilis does. AAP News teaches us that congenital syphilis is an infection of Treponema pallidum that is passed on to a fetus by an infected mother during pregnancy.
The effects of this — infants born with skeletal deformities and facial defects. Some infants are born blind or deaf, and as high as 40% of congenital syphilis infants born to mothers who do not get treatment are stillborn or die early.
Are dating apps to blame?
So, we know congenital syphilis is on the rise. The next logical step is to ask why. In 2018, a CDC report revealed there were nearly 2.4 million cases of chlamydia, gonorrhea, and syphilis reported in the United States, the highest cumulative number in U.S. history. Experts point to the rise of online dating apps like Tinder, Bumble, and Grindr that supply easy access to anonymous hookups. Part of the problem [with apps], health officials say, is that they, “Make it harder for health investigators to track outbreaks.”
And with HIV preventions on the market like PrEP (pre-exposure prophylaxis), statistics show that men who have sex with men engage more in condomless sex than men who have sex with women only.
But while these dating apps are as popular as ever, some like Grindr, the most popular dating app among gay/bi men, now remind users to engage in regular STD testing and share their STD status. So the burden of the recent rise of congenital syphilis cases and other STDs can’t solely rest on the shoulders of swipes. I mean, I’m sure some among us remember what college parties were like before our lives were run by ios updates and virtual friend requests. Hookups happened. So what’s the answer to why we’re seeing congenital syphilis cases skyrocket?
We’re tragically lacking in access to prevention and treatment
Stat News reminds us that, “These deaths and physical problems [related to congenital syphilis] are preventable tragedies: Testing is cheap and widely available and treatment with antibiotics is highly effective.”
While this is true, we also must take into account that even with the availability of free STD testing, a stigma exists with STDs and even STD treatment. In a previous story we published on Medium, we noted the reluctance of sexually active, consenting adults to use condoms when having sex. In reviewing a study published in the Journal of Sex Research, interviews and surveys show people went without condoms knowing it was the best way to prevent HIV and STDs because they didn’t want the other party to think they were promiscuous.
Although a valid concern, this type of thinking is in line with a society still suffering from a stigma of condom use, STDs, and STD screening.
So to solve the congenital syphilis crisis in America, it is not enough to just make testing available. We must eradicate the stigma of STDs and make talking about our sexual health socially acceptable.
How do we do that?
Well, might I reflect on two national movements that have sparked conversation and moved the needle toward a more just society?
What Sexual Health Advocates can learn from the #MeToo Movement and #Blacklivesmatter
Both #MeToo and #BLM have sparked national conversations about inequalities regarding sex, gender, and race. And while these issues have not been solved, these respective movements have sparked debate about ways in which our society can be unjust for marginalized groups. These conversations, or considerations, have become more common. Over time, they will cease to be hard conversations and just be conversations.
The same must happen when it comes to STDs and stigma. Starting the conversation and keeping it going until stigma fades is key for people to go without shame or embarrassment related to STD testing and/or positive results.
A tall task? Yes. Here’s some quick history on why.
The United States is notorious for censoring sex and sexuality based on religious morals. Kristy Slominskiis, assistant professor of religion, science and health at the University of Arizona, chronicles the history of sex education in this country in an article titled, Sex on the Curriculum, and writes, “In 1996, abstinence-only received an enormous boost of federal funding ($50 million a year), supporting the message that ‘a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity.’…Abstinence-only federal funding has remained fairly consistent, with only a brief lull for less than a year under the Barack Obama administration, during which time a separate funding stream was made available to comprehensive sexuality education.”
With battles over sex education, and arguments over what is deemed a moral or deviant sex act being such a substantial part of U.S. history, it’s no surprise shame and guilt are often to blame when it comes to unsafe sex practices.
And while rewiring generations of conditioned views about sex isn’t the goal here, understanding its influence can reveal strategies we must take to combat the rise of congenital syphilis.
The importance of ongoing Advocacy and access to STD treatment
According to Dr. Ina Park, 80% of U.S. counties reported zero cases of congenital syphilis in 1999 so, “The CDC launched an elimination campaign,” assuming the threat was nonexistent.
But just two years later, the dormant disease reared its ugly head, and numbers of syphilis cases began to increase. Thus, the CDC’s celebratory campaign was premature. And as devastating as misinformation like this is on the whole, it’s exponentially greater for vulnerable demographics.
People who suffer from syphilis most are people of color, the homeless population, and those who live below the poverty line. These groups fall through the cracks when it comes to education and treatment because they lack the resources needed to address health concerns with the regularity it takes to satisfy basic care, which most people take for granted.
Dr. Park notes that “One-third of congenital cases occur because the mother is not adequately treated before delivery,” and stats from the Centers for Disease control give us a closer look into the demographics for which this is a common occurrence.
The graph above shows that common demographic and clinical factors associated with congenital syphilis included the race/ethnicity of the mother (39.1% non-Hispanic black, 31.5% Hispanic, 21.9% non-Hispanic white).
Two eye-opening data points where there is a vast difference among the three racial groups are the misinformation and a lack of adequate treatment despite a timely diagnosis of syphilis, categories. These percentages are higher for Black and Hispanic mothers across the board, but significantly higher than that of their white counterparts in the south.
These glaring gaps in care are being coined as missed opportunities yet with AHF and several health journals sounding the alarm on congenital syphilis, it begs the question of why County officials in L.A. and across the nation have been slow to take action against concerns in early reports. The following graph shows the total number of “missed opportunities” in congenital syphilis cases regardless of a person’s demographic.
The tragedy in these numbers is why the AIDS Healthcare Foundation has been at the forefront of the fight against congenital syphilis and has, “Aggressively promoted syphilis awareness, prevention and treatment.” Since 2017, AHF has worked to alert County officials and the general public about the dangerous waters the city of Los Angeles was entering concerning the rise of congenital syphilis cases.
Our efforts have included a billboard campaign placed around L.A. headlined ‘Syphilis Can Be Fatal to Your Baby,’ after cases leaped from just 6 in 2012 to 44 cases in 2017. That campaign was relaunched in September 2021 to continue the conversation around the dangers of congenital syphilis by providing education about syphilis and access to testing and treatment in cases of infected mothers.
If we don’t take action, the CDC provides a snapshot of what direction these numbers will go in. Spoiler alert, it’s not down.
Proper care takes more than one visit
AHF not only provides free STD testing but is actively building infrastructures for free medical care and adaptive-use housing to serve the communities most affected by STDs. It must be understood that lack of shelter limits a person’s ability to be consistent with testing, retesting, and treatment.
If you want to spread the word, read below for the how-to on stopping the surge of syphilis.
How to Reduce your risk of getting syphilis before and during your pregnancy (CDC)
- Being in a long-term mutually monogamous relationship with a partner.
- Using latex condoms the right way every time you have sex.
*Although condoms can prevent transmission of syphilis by preventing contact with a sore, you should know that sometimes syphilis sores occur in areas not covered by a condom, and contact with these sores can still transmit syphilis.
How can I reduce the risk of my baby getting Congenital Syphilis (CDC)
- Get a syphilis test at your first prenatal visit.
- Reduce your risk of syphilis transmission before and during your pregnancy.
AHF co-founder and President Michael Weinstein said, “These numbers [of congenital syphilis] and the real lives — and sometimes deaths — of the babies and mothers they represent demand an immediate, greatly stepped-up response by County Health officials. Somehow, L.A. County must now vastly increase the availability of prevention education, testing, and treatment for syphilis.”
Where city officials may be slow to act, and health care workers’ efforts are stifled over by COVID-19, the public should feel empowered to right the ship of congenital syphilis. To move the needle forward we need education, prevention, and treatment at every turn. And that’s where you come in.
Help start the conversation. It’s as easy as sharing what you learned in this post at the watercooler, or in your Zoom-chat side convos. Because the more we get the conversation going, the better chance we have at keeping infants and their mothers healthy.
