After years of reducing the number of babies born with syphilis, Louisiana is seeing the highest number of such births in decades, following a national pattern that suggests a wide-reaching health crisis.
Nationwide, nearly 3,700 babies were born with syphilis in 2022, about 11 times the number of babies born with the infection a decade earlier, according to a report released Tuesday from the federal Centers for Disease Control and Prevention.
Although the report did not release state-by-state numbers, data from the Louisiana Department of Health shows the state makes up an outsized share of those cases, with 115 newborns with syphilis in 2022.
Just 32 babies were born with syphilis in Louisiana a decade ago.
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Syphilis in pregnancy can have dire consequences for a developing fetus. The bacterial infection, which is typically contracted through sexual activity with an infected person and can be transferred to the fetus during pregnancy, brings with it a 1 in 4 risk of stillbirth, a 14% risk of infant death and only a 1 in 5 chance of an infected mother giving birth to a healthy, uninfected infant.
Babies who survive can have bone malformations, blindness, deafness and other developmental delays.
Nine out of ten cases could be prevented with proper treatment in pregnancy, according to the report.
"We should really have zero cases of congenital syphilis in this day and age," said Patricia Kissinger, an infectious disease epidemiologist at Tulane University. "We have the way to screen, we have the way to test and we have the way to treat. But it doesn't always happen that way."
From 11 to 115 cases
As a pediatric infectious disease specialist, Dr. Monika Dietrich gets calls from across the state to consult on everything from HIV to rare bacterial infections among Louisiana's youngest patients.
Lately, congenital syphilis is a regular feature of her consultations, said Dietrich, who is an assistant professor at Tulane University School of Medicine. Three or four times per week, she gets another call from pediatricians in Louisiana and Mississippi about a newborn with syphilis, which requires a complicated treatment protocol.
"Everybody in our section, we all know the recommendations by heart at this point," said Dietrich.
Just over a decade ago, congenital syphilis would have hardly been on her radar. In 2009, the state of Louisiana saw 11 cases. By 2022, the case rate increased by nearly 1,000%. Even a smattering of cases is considered a breakdown in public health services.
Louisiana was a one-time success story for aggressively rooting out the disease. It ranked first among states in terms of the number of babies per capita afflicted with the disease in 2016, but public policy actions helped the state drop to seventh by 2020.
By 2021, the progress started to slide, and the state climbed to third among states.
In 2022, seven babies with syphilis died. State-by-state rankings are not yet available for 2022, but 115 is the highest number of babies born with syphilis in Louisiana in decades.
Louisiana's approach
The state health department made infant syphilis a priority about ten years ago. In 2014, a law was passed that required syphilis and HIV testing at the first prenatal appointment, again in the third trimester and at delivery if testing isn't noted in medical charts.
"In the subsequent years, our ranking decreased from one to three, then three to five and from five to seven in the nation," said Dr. Stephanie Taylor, medical director at Louisiana Office of Public Health STD, HIV, and Hepatitis Programs and professor of medicine at Louisiana State University. "Though these numbers are still high, considering our history, we really thought this was a substantial impact."
Louisiana took a boots-on-the-ground approach that included disease intervention specialists, or "super sleuths," said Taylor. They do contact tracing to interrupt the chain of infection.
State officials sent 70 letters to the providers of any pregnant woman who had a positive test outlining treatment protocols. A pilot program provided rapid tests for emergency rooms so pregnant women could be treated before leaving the hospital.
Still, the numbers rose, even as the fertility rate trended downward and fewer babies were born. Taylor pointed to rising rates of syphilis in men as one possible contributor to the increase. There is only one standalone STI clinic in the state, she said.
"Whenever you have the rates going up in the community or in men, they're going to go up in women and therefore cascade into children," said Taylor.
Treatment
Early cases of syphilis in pregnancy can be treated with one shot of the antibiotic benzathine penicillin G. Later cases require multiple shots given over weeks.
"That's one of the greatest tragedies of this," said Dietrich. "It's a very simple blood test. The solution to fix it is usually three weekly shots, and you're good to go."
State data show that about 18% of the pregnant women linked to a baby with syphilis did not receive any prenatal care before delivery. Of those who did get to a doctor at least two months before giving birth, almost all — 93% — were tested for syphilis at least 45 days before delivery, the window of time needed to treat the baby. But only about half were retested later in the pregnancy, giving an infected partner a chance to reinfect or infect the pregnant woman before birth.
Syphilis in babies can also be difficult to diagnose. It's not always clear at birth whether the infant has been exposed to syphilis or if they were infected. Babies who look typical may later develop syphilis. Providers normally err on the side of caution, which puts newborns through a process of medical intervention. They have a blood draw for testing, a spinal tap to check for syphilis in the brain and an IV that drips medication into the infant for ten days.
Most hospitals move the baby to the intensive care unit for the duration of the treatment. That makes it hard for moms to stay with the baby.
"We might be impacting some of that early attachment," said Dietrich.
Even babies who receive treatment may have problems down the road, such as delayed learning, inflammation in the eyes that interferes with vision and bone problems that result in bowed legs severe enough to require surgery.
Rarely, babies are born with severe symptoms like liver enlargement, rash and bone inflammation. Such a severe case at birth used to be rare, something neonatologists might see once every few years, if that.
Dietrich has seen two in the last few months.
"If a mom had been adequately treated, that can be prevented," said Dietrich.
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Emily Woodruff
The Times-Picayune | The New Orleans Advocate
