May 16, 2024
Texas physicians are raising the alarm as cases of congenital syphilis, a dangerous illness for fetuses and newborn babies, are surging.
Texas has the fourth highest congenital syphilis case rate in the nation, with cases skyrocketing 148% from 2017 to 2022, according to Texas Department of State Health Services data.
Syphilis is “the great imitator” and “the great masquerader” for its ability to go undetected, say Emily Adhikari, MD, who leads the Texas Medical Association Workgroup on Syphilis and Congenital Syphilis, and Emma Dishner, MD, a Dallas infectious diseases specialist.
“It’s often dormant, without causing bothersome symptoms – that's part of the trouble,” said Dr. Adhikari, who is also an assistant professor in the division of Maternal-Fetal Medicine at UT Southwestern Medical Center’s Department of Obstetrics and Gynecology. People do not know they are infected, and they can spread it.
Syphilis is a sexually transmitted infection. Congenital syphilis occurs when a pregnant mother with untreated syphilis passes the infection to her unborn baby. Congenital syphilis may lead to miscarriage, stillbirth, premature birth, and death immediately after birth. If left untreated, congenital syphilis can cause developmental and unexpectedly harmful health problems for the child.
The disease disproportionately affects children born to Black and Hispanic mothers. Approximately seven out of 10 infants born with congenital syphilis are in these groups. “Our experience suggests this is related to health inequity and disparate access to preventive health care, screening, and education about sexually transmitted infections,” said Dr. Adhikari.
In Texas, a pregnant person should be tested for syphilis three times during pregnancy: at their first prenatal visit, after 28 weeks gestation, and at time of delivery.
To create more awareness about the disease, Dr. Dishner says it is important to talk about it even though it can be uncomfortable.
“There is a misconception that syphilis is only prevalent in people who are younger, more sexually active, and [fall into] a promiscuous subset like sex workers or men who have sex with men… but it exists for everyone,” said Dr. Dishner, who added that she often treats syphilis patients who do not fit such stereotypes. “Patients come into my office with positive syphilis tests who are in long-term, monogamous relationships but never got tested prior.” She said the infection is more common in those aforementioned populations.
High-risk groups should be vigilant, and others need to be aware, too.
Both Dr. Adhikari and Dr. Dishner also encounter confused patients unsure about where their infections came from, saying many patients believe – incorrectly – that syphilis has flatlined across the country.
Dr. Dishner said patient education for syphilis mirrors that of other sexually transmitted infections, including advocating for regular testing, use of condoms during sexual intercourse, and discussing sexual activity and treatment plans.
One obstacle to treatment, however, is a shortage of the best remedy. “Physicians may struggle in some areas to access appropriate treatment for syphilis in pregnant individuals, for whom penicillin is currently the only option to ensure adequate treatment of the fetus,” said Dr. Adhikari, who also is the medical director of perinatal infectious diseases at Parkland Health.
As cases rise and treatment options remain limited, TMA experts highlight the need for physicians to raise awareness – including pediatricians, family and emergency physicians, and those in the infectious disease field.
“The need is urgent,” said Dr. Adhikari.
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