In the United States, sustained public health efforts virtually eradicated syphilis 20 years ago. Stopping outbreaks relied on systematic screening and treatment of this sexually transmitted infection (STI) among infected people, as well as tracing, testing and treating their sexual partners.
With the closure of STI testing and treatment centers and layoffs of public health personnel, syphilis has made a comebackwith “catastrophic” consequences for newborns of infected mothers. Statewide budget restrictions implemented in 2015 led to the closure of many clinics and a reduction in public health staffing.
In the United States, the rate of maternal syphilis tripled between 2016 and 2022reaching 280.4 cases per 100,000 births in 2022, according to the Centers for Disease Control and Prevention (CDC).
Cases are increasing even faster in the MississippiOr the rate of maternal syphilis infections increased by more than 1,000% between 2013 and 2023according to a study published in JAMA Network Open. During this decade, the number of maternal infections in Mississippi increased from 86 to 1,016 cases per 100,000 births.
The rates of congenital syphilis have been increasing for 12 consecutive years, with nearly 4,000 cases recorded in 2024according to the CDC.
Mississippi faces unique health challenges, including a high poverty rate and large numbers of people without health insurance. In August, the state declared a state of health emergency due to the sharp increase in the infant mortality rate.
Syphilis is more common in people with opioid use disorder, as well as those who have been incarcerated or lack health insurance.
Regarding maternal syphilitic infections in Mississippi, “it’s easy to understand that our situation could foreshadow that of the rest of the country,” said the study’s lead author. According to him, the high rates of maternal and child syphilis, although preventable, reflect the failures of the public health system.
The study found that the risk of maternal syphilis was highest among black women, women under the age of 24, single women, and those who did not receive full prenatal care.
This study should raise public health alarms, according to an editorial by Dr. Robert L. Cook, professor of epidemiology at the University of Florida.
However, CDC budget cuts could make it more difficult to track syphilis cases and recruit public health personnel, Dr. Cook writes. The Trump administration drastically cut public health funding and closed CDC laboratories that tested for STIs and hepatitis.
In his editorial, Dr. Cook highlights a national shortage of injectable penicillinthe only medicine authorized to treat syphilis during pregnancy. He notes that public health agencies are alerting health professionals to this shortage and encouraging them to give priority to pregnant women.
The U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists both recommend screening pregnant women for syphilis. At least ten US states – Alabama, Arizona, Colorado, Georgia, Maryland, Mississippi, Missouri, North Carolina, Tennessee and Texas – now require syphilis screening during pregnancy. However, screening during the first trimester of pregnancy is insufficient, because women who, after being screened and treated early in pregnancy, were reinfected by the same partner before delivery.
In Franceduring pregnancy, screening is mandatory for pregnant women, ideally during the first 3 months of pregnancy. This examination is carried out during the first consultation.
It can be offered even before pregnancy during the preconception consultation.
During pregnancy, screening is repeated during the 3rd trimester, ideally before the 28th week of pregnancy, in women at risk of syphilis. That is to say pregnant women:
- having unprotected sex with a new partner after the first screening;
- whose spouse is in this situation.
Source : CIDRAP
