Increase in Cases of Congenital Syphilis in 2022

Increase in Cases of Congenital Syphilis in 2022

March 8, 2023

Dear Colleague,

The Virginia Department of Health (VDH) requests your support in responding to a concerning increase in cases of congenital syphilis.  Congenital syphilis is a preventable condition caused by untreated syphilis during pregnancy, with potentially severe consequences for infected infants. In 2022, 20 congenital syphilis cases were reported in Virginia, the highest number in over three decades.  This follows several years of increases which parallel a similar rise in early syphilis diagnoses among women of reproductive age in Virginia communities. In addition, VDH has received reports of seven stillbirths due to syphilis infections during pregnancy between 2012-2021.[1]

Data associated with the congenital syphilis cases reported to VDH between 2012-2021 reveal significant disparities. Congenital syphilis cases have risen among all Virginia populations, but the number of diagnoses among Black/African American and Hispanic infants are disproportionately high. More than 34% of mothers of infants diagnosed with congenital syphilis had late or no prenatal care prior to delivery. Substance use during, or the year prior to, pregnancy was reported in 11% of cases.

VDH recommends the following actions for health care providers:

1. 1. Take a thorough sexual health history from all patients as part of routine medical care.
   2. Test for sexually transmitted infections (STIs) following CDC’s screening guidelines for all patient populations.
      1. Screen all pregnant women for syphilis during the first trimester or at their initial prenatal visit.
      2. Re-screen pregnant women for syphilis early in the third trimester (28-32 weeks) and again at delivery if at higher risk (lives in a community with high syphilis morbidity or is at risk for syphilis acquisition during pregnancy (drug misuse, STIs during pregnancy, multiple partners, a new partner, partner with STIs).
      3. Test for syphilis at the time of delivery in all women who deliver a stillborn infant (after 20 weeks).
      4. Test for syphilis at delivery, or before discharge from the hospital, for women who did not receive any prenatal care and/or who were not screened during pregnancy.
   3. Stage syphilis correctly to ensure appropriate treatment. Assess for signs and symptoms of syphilis in last 12 months to determine if early or late syphilis.
      1. Refer to the CDC STD Treatment Guidelines for syphilis for full details on the recommended treatment regimen for each syphilis stage.
      2. Benzathine penicillin G in a regimen appropriate for the stage of infection is the only recommended treatment for syphilis during pregnancy. Patients who are allergic to penicillin must be desensitized and treated with benzathine penicillin G.
      3. Pregnant women diagnosed with late syphilis must be treated with 3 doses exactly 7 days apart.
      4. Pregnant women who miss any doses must repeat the full course of therapy.
      5. Perform HIV testing for all women diagnosed with syphilis.
   4. Report syphilis diagnoses to your local health department as soon as possible.
      Inform your patients diagnosed with syphilis that the health department will contact them to offer follow-up counseling and confidential partner services.
      a.  Disease Intervention Specialists (DIS) are public health staff who are trained to follow up with partners and offer testing and treatment services. They can  also assist with the staging of syphilis diagnoses.
      b. It is important that all partners of patients diagnosed with syphilis are also tested and treated to prevent reinfections and further transmission.                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Refer to the VDH page for health professionals for additional resources related to sexually transmitted infections.  If you have any questions or need additional information please contact Oana Vasiliu, Director of STD Prevention and Surveillance at oana.vasiliu@vdh.virginia.gov.

Thank you for your ongoing partnership in STI prevention.

Sincerely,

Laurie Forlano, DO, MPH
Acting State Epidemiologist and Director
Office of Epidemiology

 

[1] This is likely an underestimate of true syphilitic stillbirths due to incomplete reporting.