On Monday, Nov. 13, the North Carolina Department of Health and Human Services (NCDHHS) issued a public health alert following five stillbirths or neonatal deaths in babies with congenital syphilis born between January 1 and September 1, 2023.
This new alert comes on the heels of a memo that NCDHHS sent out to providers last week asking for providers’ help to prevent congenital syphilis in order to reverse an “alarming trend.”
From 2012 to 2022, according to state stats, there was a 55 percent increase in reported syphilis cases in North Carolina among women with an associated increase in congenital syphilis infections – from 1 case in 2012 to 57 cases in 2022.
According to NCDHHS, the increase isn’t only happening in North Carolina. Instead, this state trend is mirroring a national trend that was described this week by the Centers for Disease Control and Prevention’s “Vital Signs” publication.
The good thing is that congenital syphilis is preventable. The bad thing is that, if left untreated, syphilis in pregnancy can result in “miscarriages, stillbirth and neonatal death, as well as adverse life-long health impacts for the baby such as bone damage, severe anemia, enlarged liver and spleen, jaundice, nerve problems causing blindness or deafness, meningitis, or skin rashes.”
As a rule, public health agencies review each case of congenital syphilis found in the state in order to understand why the infections weren’t prevented.
A review of North Carolina’s 2022 congenital syphilis cases found the following reasons:
- Little to no prenatal care
- Missed opportunities to test women during pregnancy, as required by North Carolina’s Public Health law
- Inadequate or delayed treatment of the maternal syphilis infection.
State health leaders say that all pregnant women should be screened at least three times during pregnancy. That’s because sexually transmitted infections can still be present even if the exposure happened in the past – and even if there are no symptoms.
In fact, in 2022, 86 percent of pregnant women diagnosed with syphilis in North Carolina had no symptoms at the time of diagnosis.
Symptom-based testing alone would have missed these infections.
In addition, because many mothers of infants with congenital syphilis get little or no prenatal care, it’s important for health care providers to screen pregnant women for syphilis in other settings, such as urgent care offices or emergency rooms.
This new effort is just one of many that NCDHHS is using to fight syphilis in the state. Other recent initiatives included calling a Southeast Congenital Syphilis Payers Summit to identify policy levers that payers can use to address this growing epidemic.
The state has also implemented a public education campaign to spread awareness of syphilis and the importance of testing, so that pregnant women and their partners have access to information and treatment, and increasing access to syphilis testing by distributing point-of-care tests.
There’s a lot more information on all this on the NCDHHS Public Health website.