Congenital Syphilis Spike in Colorado Leads to Government Action

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US health officials are growing increasingly worried about rising syphilis cases and have begun creating framework to slow down the spread.

With congenital syphilis cases in the US rising over 755% in the past decade, government officials have been working to educate the public about the infection and create more accessibility for screening.1 In Colorado, cases have risen significantly, and state representatives have swiftly enacted bills created to prevent the spread of congenital syphilis.

What’s the Issue?

Congenital syphilis is the transmission of Treponema pallidum, the syphilis spirochete, from the mother to the fetus. This may result in stillbirth, premature birth, or asymptomatic complications that could cause long-term adverse effects for the child.2 As cases in the US rise, especially in Colorado, lead health officials are doing what they can to stop the spread.

Syphilis bacterium rendition

Syphilis bacterium rendition | image credit: Tatiana Shepeleva / stock.adobe.com

  • With congenital syphilis in the US increasing sevenfold in the past decade, cases peaked at over 3700 in 2022. In the same year, the CDC reported over 207,000 cases of sexually transmitted infections, with 47 states and Washington, DC, reporting at least one case of congenital syphilis.1 According to the CDC, 40% of untreated congenital syphilis cases in babies may result in stillbirth or death.3
  • In Colorado, cases soared from 7 to 50 from 2018 to 2023. In 2024 alone, the state has already reported 25 cases with 5 stillbirths and 2 deaths as a result. To address the congenital syphilis epidemic, Colorado Governor Jared Polis issued a public health order to address the increase of cases in the state.3
  • To monitor the infection and prevent any adverse effects in newborn children, testing for syphilis during pregnancy is crucial. Colorado state representatives recently passed HB24-1456, Increase Syphilis Testing During Pregnancy, to improve health outcomes for pregnant patients and their newborn children by establishing prenatal testing standards.4
  • Recent CDC reports revealed that syphilis testing parameters across the country are lacking. In Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee, screening rates for syphilis fell in the 56% to 91% range for individuals mandated to complete testing. Of the more than 3700 cases reported in 2022, 90% of them were potentially preventable.1

Why It Matters

Observing syphilis cases in Colorado, Governor Polis has called on several state departments to act swiftly in response to the growing number of cases. Polis has called on the Behavioral Health Administration, Department of Local Affairs, Department of Health Care Policy and Financing, Department of Human Services, Department of Corrections, Department of Public Safety, and Department of Regulatory Agencies to collaborate and assist the public on ensuring syphilis testing access for all pregnant patients.3

  • Polis has called for a greater frequency in testing to stunt the growth of syphilis cases in his state because of its inability to be detected. “It is possible to have syphilis and not know it. Untreated syphilis in those who are pregnant can also lead to pregnancy loss, preterm delivery, and permanent medical conditions (blindness, deafness, developmental delays, or bone abnormalities) in babies. Some babies with syphilis can be healthy at birth, but develop life-altering complications later in life,” according to Polis’ press release.3
  • Between Polis’ public health order and HB24-1456, accessibility to syphilis testing is growing rapidly in the state of Colorado. But with the syphilis epidemic expanding across the nation, it’s important for government officials and the public to be educated on the issue. And with Colorado taking swift action to address the epidemic in 2024, it’s likely other states will quickly follow suit if the spread worsens.

Expert Commentary

  • “Syphilis was once a rare disease. We are very concerned about this growing epidemic, both in the state and nationally. It is devastating for babies, but there is an effective treatment if caught in utero. The public health order that I am issuing will help us catch more of these cases prior to birth,” Jill Hunsaker Ryan, executive director, Colorado Department of Public Health and Environment, said about Governor Polis’ public health order.3
  • “Congenital syphilis can cause birth defects and unfortunately, even death. As a state, we’re stepping up to address this public health crisis,” said Representative Lindsey Daugherty, a sponsor of HB24-1456.4“This bill works in tandem with Colorado’s public health order to ramp up syphilis screening for pregnant people throughout their pregnancy. Congenital syphilis can be treated simply, and encouraging screening is an important step forward in combating this public health crisis that’s affecting many of our communities. Our goal is to stop the rise in congenital syphilis and create a safer, healthier Colorado for all.”
  • “An aggressive and coordinated all-state response is appropriate at this stage of the epidemic,” said Scott Bookman, senior director for Public Health Readiness and Response, CDPHE.3 “Testing and immediate treatment are available at little or no cost. Our goal now is to get those services to Coloradans who need them as quickly as possible.”

READ MORE: Education, Testing Necessary to Reduce Stigma and Combat Increases in STIs

In Depth Insights

With more accessibility to syphilis testing in the works, Colorado officials informed the public on when to appropriately test for the infection. The CDC also addressed the rise in cases nationally and prioritized the need for syphilis testing to focus on pregnant patients and babies.

  • Health care providers should offer syphilis tests at certain timeframes during pregnancy to prevent cases of congenital syphilis. Tests should be offered in the first trimester (1-12 weeks of pregnancy), in the third trimester (28-32 weeks) and at the time of birth. Pregnant patients should also receive congenital syphilis testing if there is a miscarriage after 20 weeks or a stillbirth. Tests should be provided in prisons and jails, or if a patient is required to visit the emergency room or urgent care during pregnancy.3
  • “Since June 2023, syphilis treatment has been affected by a global shortage of injectable benzathine penicillin, leading the CDC to advise prioritizing its use for infections in pregnant patients and babies with congenital syphilis,” wrote Kenny Lin, MD, MPH, for the American Family Physician.1 This shortage could be the cause of 2024’s spike in congenital syphilis in the US. While syphilis can affect any individual, congenital syphilis is especially dangerous for infants and pregnant patients.

Extra Reading

References
1. Lin K. Prenatal and congenital syphilis cases continue sharp rise in the United States. American Family Physician. February 5, 2024. Accessed April 25, 2024. https://www.aafp.org/pubs/afp/afp-community-blog/entry/prenatal-and-congenital-syphilis-cases-continue-sharp-rise-in-the-united-states.html
2. Hussain SA, Vaidya R. Congenital syphilis. NLM. February 10, 2019. Accessed April 25, 2024. https://www.ncbi.nlm.nih.gov/books/NBK537087/
3. Colorado takes action to address increase in syphilis and congenital syphilis cases. Colorado.gov. April 18, 2024. Accessed April 25, 2024. https://www.colorado.gov/governor/news/colorado-takes-action-address-increase-syphilis-and-congenital-syphilis-cases
4. Bills to prevent syphilis, improve support for Coloradans with sickle cell disease pass committee. Colorado House Democrats. April 23, 2024. Accessed April 25, 2024. https://www.cohousedems.com/news/bills-to-prevent-syphilis
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