In Missouri and throughout the United States, syphilis rates are rising. According to the Centers for Disease Control and Prevention, syphilis rates increased by 80% across the US from 2018 to 2022. Rates have increased for all demographic groups, including pregnant people — which has led to an increase in the number of babies being born with syphilis.
"Mom and baby, in the simplest of terms, are connected by the placenta and all the blood vessels that are forming before baby is born. And so infection, many other things can be transferred through the placenta from mom to baby. That doesn't necessarily mean that, you know, mom's the bad guy and she should be punished for it. This is just the side effect of pregnancy for many things."Brian Allen, M.D.
Congenital syphilis is the medical term for when a baby contracts syphilis from its mother while in the womb. When a pregnant person is infected with syphilis, the infection can be passed to the baby through the placenta.
Dr. Brian Allen, a pediatric infectious disease specialist with MU Health Care, said the rising trend in case numbers among women of reproductive age is especially concerning to him. Over the years, congenital syphilis rates have skyrocketed in Missouri – rising from two recorded cases in 2015 to 63 cases in 2021.
Although syphilis is a serious condition, it can be treated and cured if it's caught in time. But for babies infected with syphilis, it can be harder to catch.
According to Allen, most babies with congenital syphilis are born essentially normal, with symptoms often not appearing until later. Allen said this means that it’s important for pregnant women to be tested for syphilis. Because infections can be passed from mom to baby, doctors need to know the STI status of pregnant people to determine whether their babies may be at risk for infection.
“For us specifically in Missouri, the recommendation is [STI screening] at the very first visit as mandated by law. And then again, if there's high risk in a geographic area or high-risk behaviors in a woman, then we should be re-screening at 28 weeks in the third trimester, and then again at delivery,” Allen said.
"None of it comes from a standpoint where we're trying to make anyone feel stigmatized or feel bad. As healthcare providers, it's our duty, right, it's our job to make sure that we recognize the risks that our patients are under... So step one, I think is just making sure you have a good relationship or or establish a relationship with an OB/GYN provider or a family practitioner who does OB/GYN care."Brian Allen, M.D.
Missouri law currently requires that all pregnant people who attend their first prenatal visit receive STI screening but does not mandate further testing later in the pregnancy or at delivery. Many experts, including Allen, say that screening later in pregnancy and at delivery is extremely beneficial for catching congenital syphilis and treating it before the infection becomes harmful to a child’s health or has fatal consequences.
“Syphilis has long-term, devastating effects,” Allen said. “And specifically with regards to congenital syphilis, that can lead in many instances to stillbirth or death of a baby shortly after birth.”
While STI screening at the first prenatal visit can catch early congenital syphilis cases and treat them before they potentially lead to stillbirth, Allen said that STI screening later in the pregnancy can catch also infections that were contracted later, allowing babies to be treated before or after delivery with antibiotics.
But if the infection isn’t caught and is left to develop untreated, it can have serious long-term health impacts such as seizures, collapse and/or destruction of bones and joints, neurological issues that can result in blindness and deafness, and more. During the tertiary, or final, stage of syphilis, symptoms can become even more severe and include things like dementia, psychological hallucinations and paralysis.
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“The long-term consequences of syphilis happen kind of slowly over time. And then once they happen, it's clearly there and there's a lot of times there's damage or destruction that can't be reversed,” Allen said.
When it comes to lowering your risk for syphilis, Allen emphasized that prevention is key. Experts agree that using condoms and dental dams, receiving regular STI screening and limiting your sexual partners are the best ways to prevent contracting and spreading STIs like syphilis. And for people who are pregnant or planning to be, Allen said that it’s very important to get connected with an OB-GYN provider who can help manage sexual health and STI screening.
“Part of our personal health is going to be our sexual health,” Allen said. “If you have any concerns or any current worries — any partners — if there's any concern for anything at all, then I think talking and having an open discussion with our healthcare providers, in general, can lead to the right form of questioning, can lead to the right form of testing to understand and know your risk.”
