Before Texas physicians had a streamlined way to call someone for help regarding complex syphilis cases, Manda Hall, MD, first picked up her phone and dialed two Texas Medical Association members.
If Dr. Hall, Deputy Commissioner of Community Health Improvement for the Texas Department of State Health Services (DSHS), was going to help establish a hotline for syphilis-related issues, she needed help from Catherine “Carey” S. Eppes, MD, and Emily Adhikari, MD, two TMA leaders in their field.
“The partnership and ideas that come from TMA and the lessons we’ve learned from maternal health really led to a group that was able to collaborate and get this thing going,” said Dr. Eppes, chair of TMA Committee on Reproductive, Women’s, and Perinatal Health and a maternal-fetal medicine specialist at Baylor College of Medicine in Houston.
Driven by TMA’s collaboration with DSHS, a new syphilis hotline launched on Jan. 7 meant to help answer questions from clinicians statewide regardless of their expertise or case complexity. Any clinician can call (833) 62-ENDCS or (833) 623-6327 and speak directly to a physician consultant or nurse from 8 am-5 pm Monday through Friday. DSHS ultimately hopes to extend the hotline’s availability into weekends later in 2026.
TMA has long recognized the state has one of the nation’s highest rates of syphilis infection and called for continuing education. The number of congenital syphilis cases is even more alarming: Approximately one in four congenital syphilis cases nationwide are diagnosed in Texas.
“The hotline can offer support to those physicians or clinicians who aren’t really comfortable with interpretation or knowing what to do, how to treat and [refer] a patient if a patient needs additional monitoring,” said Dr. Adhikari, chair of TMA’s Committee on Infectious Diseases. Dr. Adhikari, along with Dr. Eppes, is available on the hotline call sheet to help answer questions.
A statewide hotline can especially help clinicians in rural areas where local health departments are stretched thin, added Dr. Adhikari, who specializes in maternal-fetal medicine as an associate professor in the Department of Obstetrics and Gynecology at UT Southwestern Medical School.
Dr. Eppes wants clinicians to call with any type of question at any point during a woman’s pregnancy.
“We want people to call every time,” Dr. Eppes said. “It’s not just if you have a question, but it might also help us map resources to the patient. Really, it’s about just getting people to call the hotline as much as possible.”
This includes calls from any physician who sees a pregnant patient, even outside obstetrician-gynecologists or maternal specialists.
Both Dr. Adhikari and Dr. Eppes are passionate about identifying and treating syphilis, and were both willing to help “without hesitation,” Dr. Hall said. “We know that we have an opportunity through this hotline and the work of all of our partners to really make a difference,” she said.
So far, this isn’t a problem that’s slowing. According to DSHS data, congenital syphilis cases more than doubled in 2022 based on the 372 cases that were reported in 2018.
If left untreated, congenital syphilis can lead to miscarriage, birth defects, or death. The risks are greatly reduced when a mother is diagnosed and treated early in pregnancy.
Infections can be treated with penicillin, but identifying the illness can be tricky. Texas law requires physicians to test pregnant patients three times to diagnose infections: at the first prenatal visit, during the third trimester (after 28 weeks), and at delivery. DSHS offers a free CME course titled “Congenital Syphilis Prevention: Screening, Diagnosis, and Treatment for Pregnant Women in Texas.”
Lawmakers recognized the situation, too. DSHS received $8.4 million and funding for 23 full-time employees to address the issue through a TMA-supported exceptional item.
“When I was in training, I saw one case in my career, and now we’re seeing these cases have a resurgence,” Dr. Hall said. “So that’s why it was so important to see this as a priority for here at our agency but also for the state of Texas.”