Congenital syphilis spike in Colorado prompts government action

With cases of congenital syphilis in the United States increasing more than 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 increased significantly, and state representatives have quickly enacted bills designed to prevent the spread of congenital syphilis.

What’s the problem?

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

• With congenital syphilis in the United States increasing sevenfold in the past decade, cases will reach more than 3,700 by 2022. In the same year, the CDC reported more than 207,000 cases of sexually transmitted infections, with 47 states and Washington, DC, that reported at least one case. of congenital syphilis.¹ According to the CDC, 40% of untreated cases of congenital syphilis in infants can result in death or stillbirth.³
• In Colorado, cases increased from 7 to 50 from 2018 to 2023. In 2024 alone, the state has already reported 25 cases with 5 deaths 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 in cases in the state.³
• To control infection and prevent adverse effects in babies, testing for syphilis during pregnancy is crucial. Colorado state representatives recently passed HB24-1456, Increasing Syphilis Testing During Pregnancy, to improve health outcomes for pregnant patients and their newborns by establishing prenatal testing standards.⁴
• Recent reports from the CDC revealed that there are no nationwide syphilis testing parameters. In Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee, syphilis detection rates fell between 56% and 91% for those required to complete testing. Of the more than 3700 cases reported in 2022, 90% of them were potentially preventable.¹

why does it matter

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

• Polis has called for more frequent testing to slow 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 pregnant can also lead to pregnancy loss, premature birth, and permanent medical conditions (blindness, deafness, developmental delays, or bone abnormalities) in babies. Some babies with syphilis may be healthy at birth, but develop life-altering complications later in life, according to the Polis news 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 spreading across the country, it’s important for government officials and the public to be educated on the issue. And with Colorado taking swift action to deal with the epidemic by 2024, its other states will likely quickly follow suit if the spread worsens.

Expert commentary

• Syphilis was once a rare disease. We are very concerned about this growing epidemic, both at the state and national level. It is devastating to babies, but there is effective treatment if it gets caught in the womb. The public health order I am issuing will help us detect more of these cases before birth, Jill Hunsaker Ryan, executive director of the Colorado Department of Public Health and Environment, said of the governor’s public health order cops³
• Congenital syphilis can cause birth defects and, unfortunately, even death. As a state, we are stepping up to address this public health crisis, said Representative Lindsey Daugherty, sponsor of HB24-1456.⁴This bill works in conjunction with Colorado’s public health order to increase syphilis screening for pregnant women throughout their pregnancy. Congenital syphilis is easily treatable, and encouraging screening is an important step in combating this public health crisis that affects many of our communities. Our goal is to stop the rise of congenital syphilis and create a safer, healthier Colorado for everyone.
• An aggressive and coordinated response from all states is appropriate at this stage of the epidemic, said Scott Bookman, Senior Director of Public Health Preparedness and Response, CDPHE.³ Testing and immediate treatment are available at little or no cost. Our goal now is to provide these services to the Coloradans who need them as soon as possible.

READ MORE: Education, testing needed to reduce stigma and combat the rise of STIs

In-depth knowledge

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

• Health care providers should offer syphilis testing at certain times during pregnancy to prevent cases of congenital syphilis. Testing should be offered in the first trimester (1-12 weeks of pregnancy), in the third trimester (28-32 weeks) and at the time of delivery. Pregnant patients should also be tested for congenital syphilis if there is a miscarriage after 20 weeks or a stillbirth. Testing should be done in jails and prisons, or if a patient has 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, prompting the CDC to advise prioritizing its use for infections in pregnant patients and infants with congenital syphilis, wrote Kenny Lin, MD, MPH, for al American family doctor.¹ This shortage could be the cause of the increase in congenital syphilis in 2024 in the US. Although syphilis can affect anyone, congenital syphilis is especially dangerous for babies and pregnant patients.

Extra reading

References

1. Lin K. Cases of prenatal and congenital syphilis continue to rise sharply in the United States. American family doctor. 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 Rising Cases of Syphilis and Congenital Syphilis. 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. Colorado House Democrats. April 23, 2024. Accessed April 25, 2024. https://www.cohousedems.com/news/bills-to-prevent-syphilis