Usually, people don’t like to talk about syphilis.

However, on Wednesday, Feb. 21, the State of North Carolina put out a press release warning residents of a dramatic increase in cases of syphilis over the years.  It also provided information about some new moves the state is taking to address the issue.

State Health Director and North Carolina Department of Health and Human Services (NCDHHS) Chief Medical Officer Dr. Elizabeth Cuervo Tilson stated in the release that the situation has been getting much worse – especially when it comes to congenital syphilis, cases where the disease is passed from a mother to her baby during pregnancy or at birth.

“Congenital syphilis is a completely preventable infection with devastating consequences,” Tilson said. “Cases are the highest they have been in 20 years. It will take a data-driven and collaborative effort to reverse this trend and ensure people are getting the care they need.”

According to the best data available, between 2012 and 2023, there was a nine-fold increase in reported syphilis cases among women, with an associated 72-fold increase in congenital syphilis infections.

And it can lead to death. Preliminary data for 2023 show nine congenital syphilis-related stillbirths and neonatal deaths.

In North Carolina, over half of the births where syphilis is passed to the baby occur with Medicaid-eligible women, which is why state officials see the Medicaid program “a pivotal player” in the fight.

In 2023, only 32 percent of women with symptomatic syphilis received same-day treatment and 34 percent of women weren’t treated until more than seven days after their syphilis diagnosis.

As part of an ongoing effort to combat rising cases of syphilis in the state, the NCDHHS is attempting to raise awareness among providers and patients of changes in Medicaid benefits that will fund more treatment.

As of February 1, the Medicaid reimbursement rate offered to medical providers has increased to make a key medication – “Bicillin L-A” – more likely to be used.  According to state health officials, it is the only known effective treatment for preventing congenital syphilis.

North Carolina proposed the change to the Centers for Medicaid and Medicare Services to increase payment to providers so they can treat people with syphilis or congenital syphilis in their offices instead of referring patients to other places for treatment. This is the first rate increase for Bicillin L-A since 2015.

The change in NC Medicaid rules follows other actions NCDHHS has taken to curb the sharp increase in syphilis and congenital syphilis cases. This includes partnering with other southeastern states “to align on recommendations for standard syphilis screening in pregnant women and for providers to adhere to the requirements around control measures for diseases like congenital syphilis, establishing a provider resource webpage, and launching a public awareness campaign.”