Under some truly horrible decisions of some truly asinine Republican legislatures, restrictions on abortion and other healthcare services for women are greatly contributing to hospital organizations having to discontinue OB/GYN care, or close down some hospitals altogether.
And the downstream effects of these asshole GOP prigs getting their slimy hands on the levers of power are beginning to show up big.
A decade ago, the United States stood on the brink of eliminating the scourge of babies born with syphilis. Now, cases are surging, a phenomenon that is underscoring deep inequities in the nation’s health-care system and reviving concerns about a disease easily controlled with routine antibiotics.
The spike, driven in part by the nation’s drug and homelessness crisis, is especially apparent across the Sun Belt, according to public health experts and data from the Centers for Disease Control and Prevention.
The rate of syphilis is five times higher for babies born to Black mothers than to White mothers, reflecting racial disparities in access to maternal health care.
Syphilis, a bacterial infection that primarily spreads through sexual contact, can be passed from mother to child through the placenta. Congenital syphilis resulted in 188 stillbirths and 23 infant deaths in 2021, according to CDC data, and can cause organ damage, profound fetal anemia and long-term complications for surviving babies.
While the overall number of infected infants seems low — nearly 2,700 nationally in 2021, or 74 of every 100,000 live births — public health officials say no baby in developed nations should be born with syphilis because most cases are preventable with testing and penicillin treatment of the mother. The fact that cases have climbed, experts say, is an indictment of the U.S. health-care system.
Oman, Cuba and Sri Lanka are among the countries that have virtually eliminated mother-to-child transmission of syphilis in recent years, according to the World Health Organization.
After steadily declining since World War II, congenital syphilis roared back in the United States to about 4,000 cases a year in the early 1990s as syphilis surged in adults. The number of infected infants dwindled to several hundred a year in the 2000s, then started climbing again in 2013.
“People thought we had gotten rid of syphilis when it in fact came back and is significantly increasing,” said Robert McDonald, who focuses on STD prevention at the CDC.
To reverse the trends, public health authorities are striving to reach women at highest risk for passing syphilis to their babies — those who are homeless, exchange sex for money, or use drugs are more likely to be exposed to the disease and less likely to seek prenatal care.
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In Portland, Ore., county workers paid for pregnant women without stable housing to stay in a hotel for three weeks to ensure they received the three-shot regimen needed to quash the bacterial infection.
In Atlanta, a clinic hailed an Uber to bring a pregnant woman with syphilis to her third appointment for a penicillin shot when she couldn’t secure a ride.
In Los Angeles, the county jail began syphilis screening for female inmates, and the health department is planning to hold events where women experiencing homelessness could receive STD screenings alongside clothes, showers and food.
“These things are all kind of converging and creating this social milieu in which we are seeing this preventable infectious disease end up with tragic outcomes,” said Sonali Kulkarni, who leads the STI prevention division of the Los Angeles County Department of Public Health.
Health officials say the pandemic made it harder to respond to sexually transmitted diseases as dwindling staff and money were redeployed to covid. Compared to the novel health threats that captivate public attention like the coronavirus, mpox and bird flu, syphilis can seem like old news.
The first step to saving a baby from being born with syphilis is identifying whether the mother is infected. But just a few states — Arizona, Texas and North Carolina — require the most comprehensive syphilis testing covering the first visit, third trimester and at delivery, according to a 2021 review of laws compiled by the CDC.
The CDC, in examining congenital syphilis cases from 2020 with medical histories available, found that 41 percent had no timely prenatal care or testing. Nearly as many were diagnosed with syphilis but did not receive adequate treatment.
When a pregnant woman tests positive for syphilis, the only recommended treatment to prevent a congenital case — Bicillin L-A — can be hard to come by. Pfizer is the only manufacturer, and there’s no generic version. It’s so expensive that pharmacies and private health providers often don’t stock it, making it difficult to immediately start providing treatment. Public health departments are the most likely to have the shots on hand.
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In rare cases, patients who did receive timely testing and treatment still risk passing the infection to their babies.
In early March, a 32-year-old Houston mom held her newborn son with a full head of brown hair for mere minutes before doctors whisked him to the neonatal intensive care unit to begin treatment for congenital syphilis.
The mother, who spoke on the condition of anonymity to discuss her medical history, said she still tested positive for syphilis at delivery despite having already had two rounds of treatment during her pregnancy.
Doctors performed a lumbar puncture, or spinal tap, on the boy to test for neurosyphilis, which occurs in 60 percent of babies with symptoms. After 10 days in the NICU, during which her son received penicillin through a tiny intravenous line, the woman was able to bring him home. But much uncertainty lies ahead.
“You don’t want to lose somebody before you get to know him,” she said.
She must bring her son back to the hospital for follow-up visits every two months for a year because syphilis and its effect on babies is stubbornly hard to detect, said her doctor Irene A. Stafford, a maternal-fetal medicine physician at the University of Texas Health Science Center.
A newborn rests beside his mother Dailyn Fleite, left, 29, at the Ana Betancourt de Mora Hospital in Camaguey, Cuba, in 2015. The World Health Organization declared Cuba the first country in the world to eliminate the transmission of HIV and syphilis from mother to child. (Alexandre Meneghini/Reuters/Alamy)
Stafford said she sees the consequences of the syphilis resurgence in her patients every day. One in 555 babies in Texas is born with congenital syphilis, according to the Texas health department.
She said she’s haunted by a case of a teen mother who was being trafficked by a relative and had received little to no prenatal care. Although she visited the emergency room complaining of symptoms during her pregnancy, she was never screened for syphilis and birthed a baby with neurosyphilis. The baby is now 5 years old and still can’t swallow solid food. The child requires speech and physical therapy and care in multiple pediatric specialties.
The teenager got pregnant again after an incomplete treatment regimen and birthed a second child with syphilis. Today, she is homeless, and her mother cares for the children.
Studies show that about half of women with syphilis don’t report risk factors such as transactional sex, substance abuse, unstable housing and sexual violence because they may fear losing custody of their children, Stafford said; as a result, they don’t get the robust screening that could lead to treatment for them and their babies.
Most women do not know they have syphilis because it doesn’t hurt, doesn’t burn, doesn’t itch. Any symptoms that develop are often vague and can be missed by even the most astute physician, said Stafford, who has received a federal grant to develop a simpler syphilis test for moms and newborns.
In Phoenix, staffers at Hushabye Nursery, a nonprofit that provides care for babies suffering from opioid withdrawal, said the recent rise in infants born with syphilis is especially alarming because the babies who need a quiet, dark environment to mitigate the pain of withdrawal must instead spend 10 days in loud, bright neonatal intensive care units to receive treatment for syphilis. After partnering with health departments in the fall to increase syphilis screening, the nursery was able to prevent three potential cases of congenital syphilis by getting the mothers into treatment, said nursery co-founder Tara Sundem.
The University of Chicago Medical Center started screening emergency room patients for syphilis in 2019, bringing testing and treatment to the place where high-risk women experiencing homelessness and addiction tend to seek medical care. This kind of universal syphilis screening at hospitals remains rare even though it can prevent congenital syphilis.
In Multnomah County, Oregon, which includes Portland, public health workers are conducting more outreach in homeless encampments and shelters as they saw a rise in syphilis infections in people who reported using drugs, often while living on the streets. In one instance, a pregnant woman who lived in a tent under a bridge received her syphilis diagnosis and first penicillin shot at an emergency room but resisted coming back. A county nurse came to her tent to bring the next two shots.
Some experts attributed the uptick in cases to varying state policies on screening. Eleven states, mostly in the Southeast, have yet to expand Medicaid to all low-income adults, which would cover the costs of syphilis testing and treatment. That leaves pregnant people, whose medical care is supposed to be covered by Medicaid, susceptible to reinfection if their partners remain untreated.
“It’s frustrating because if timely interventions are deployed, you can totally turn this condition around,” said Mark Turrentine, a professor of obstetrics and gynecology at Baylor College of Medicine in Houston.
Sarah Nadia Ali, director of infectious diseases at Mary’s Center, said the D.C. community health center has tried to remove barriers to screening at its walk-in sexual health center that accepts people without insurance. (Bonnie Jo Mount/The Washington Post)
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Several states, including Mississippi in March, have strengthened their screening requirements in recent years in response to the rise of congenital syphilis.
But the closure of rural hospitals and OB/GYN services has created “monumental” geographical gaps in accessing prenatal care, said Thomas Dobbs, Mississippi’s former public health director. “If you are a working mom who maybe doesn’t get much sick time — or any sick time — and you have a 100-mile drive just to get to a prenatal care visit, that’s a huge impediment,” Dobbs said.
Even if care were readily accessible, public health experts say many expectant Black mothers don’t believe doctors have their best interests at heart because of the medical establishment’s long history of mistreating Black patients.
Joseph Kanter, Louisiana’s top health official, says he has treated patients who had cases of congenital syphilis in their family because of the infamous Tuskegee experiments, in which hundreds of Black men were left untreated for syphilis to study the long-term effects of the disease. That has created a tragically ironic situation: The failure to treat syphilis in Black adults made their descendants more skeptical of a medical system that could provide treatment to prevent syphilis in Black babies.
“The issue of congenital syphilis is deeply intertwined with a history of institutional racism,” Kanter said, noting that 65 percent of congenital syphilis cases in Louisiana are among Black babies. “We are dealing with a lot of earned mistrust.”
Public health experts say the country has the capability to end congenital syphilis, often drawing parallels to transmission of HIV from mother to child — which declined from 1,760 in 1991 to fewer than 40 in 2019. That plunge was a result of a national public health campaign with sustained funding to adopt universal screening, put doctors on alert and ensure that pregnant people with HIV received antiretroviral therapy and did not breastfeed their children.
“The same focus has not been on congenital syphilis,” said Rebekah Horowitz, director of STI programs at the National Association of County and City Health Officials. “Without the focus and the funding, it won’t end.”
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