In recent years, the United States has witnessed a troubling increase in syphilis cases, reaching levels unseen since the 1950s. The American College of Obstetricians and Gynecologists has responded by recommending more rigorous testing during pregnancy.
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It often goes unnoticed due to its subtle symptoms, making it a silent but devastating threat to health.
Laura E. Riley, chair of the obstetrician coalition’s immunization work group, says, “Sometimes, it’s difficult to know that you’ve been exposed to syphilis, and it’s not like you can raise your hand and say, ‘I have this, please give me treatment,’ because you may not even know you have it.”
According to the Centers for Disease Control and Prevention, reported syphilis cases saw an alarming 80% increase from 2018 to 2022, rising from about 115,000 to over 207,000 cases. In 2022 alone, more than 3,700 babies were born with the disease, leading to 231 stillbirths and 51 infant deaths.
Syphilis can cause severe complications for both the pregnant individual and the unborn child. If left untreated, the infection can advance, damaging various organs and nerves.
More alarmingly, syphilis can be transmitted from a pregnant person to the fetus, resulting in congenital syphilis. This condition can lead to severe health issues for the baby, including premature birth, low birth weight, developmental delays, and other complications.
Given the surge in syphilis cases and the associated risks, the American College of Obstetricians and Gynecologists has updated its recommendations. They now advise a routine blood screening at the first prenatal visit, as well as screenings in the third trimester of pregnancy and at birth.
This is a significant change from the previous recommendations, which suggested testing in the third trimester only for those at higher risk — individuals living in communities with high syphilis rates or those at risk of syphilis exposure during pregnancy. Despite the clear need for testing, stigma around sexually transmitted infections remains a barrier.
Nicole Smith, medical director of maternal-fetal medicine at Brigham and Women’s Hospital in Boston, commented, “Some populations are less likely to be either screened or treated … due to the locations where they’re receiving care or because there’s a concern among that population that they’re being stigmatized because they’re being tested.”
Treatment for syphilis is relatively straightforward. A single injection of a long-acting dose of penicillin can cure early-stage syphilis. For late-latent syphilis or when the duration of the infection is unknown, the CDC recommends three doses of long-acting benzathine penicillin G, administered weekly. While this treatment can eliminate the infection and prevent further damage, it cannot reverse damage that has already occurred.
One challenge in managing syphilis is ensuring access to testing and medication. Drug shortages, a long-standing issue for many medications, have contributed to the rise in syphilis cases.
In April 2023, the Food and Drug Administration announced a shortage of penicillin in the United States due to increased demand. To address this, the FDA granted temporary approval for the importation and distribution of a French drug, Extencilline, used for syphilis treatment but not FDA-approved.
The updated guidance from the obstetricians group is crucial as it makes physicians aware of alternative treatments for syphilis amid the shortage.
In June 2023, Pfizer, the maker of penicillin, announced it would prioritize making the drug available, with the shortage expected to be relieved within the next few months of this year.