U.S. sees concerning rise in STIs, congenital syphilis with no signs of slowing

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• John Yang:

  New numbers from the CDC show a surge of sexually transmitted infections in the United States with no signs of slowing. In 2021, there were 2.5 million cases of chlamydia, gonorrhea and syphilis. The most significant rise was in syphilis and congenital syphilis, which occurs when mothers with the infection pass it along to their babies during pregnancy. From 2020 to 2021, cases of each went up 32 percent. Ali Rogin has more on this concerning trend.

• Ali Rogin:

  Over the past decade, there's been about an eightfold increase in the cases of congenital syphilis in the United States. In 2012, the numbers were at historic lows thanks to robust contact tracing and public health efforts. But infections have gone up every year since. And syphilis in babies is much more serious than in adults carrying a risk of stillbirth and long term health problems.

  Here to talk about what can be done to address this is Dr. Irene Stafford. She's an OBGYN and maternal fetal medicine specialist at UT Health, Houston. Dr. Stafford, thank you so much for joining us. Let's talk first about why STIs in general are on the rise in the United States.

  Dr. Irene Stafford, The University of Texas Health Science Center at Houston: Thank you again so much for having me. The rise in STIs in this country is multifactorial. Part of it is inconsistent screening patterns, especially with people that are in special risk groups. Unfortunately, our emphasis should be placed on offering and encouraging routine screening for STI in every health encounter.

  Sexual health in general really seems to be underemphasized due to a lack of screening. Unfortunately, other significant issues such as access to care, funding, lack of available clinics, all of these factors contribute to the rising rates of STI.

• Ali Rogin:

  And then how about congenital syphilis in particular? Is that part of the overall increase in STIs that we're seeing?

• Dr. Irene Stafford:

  As a matter of fact, there's been over a 30 percent increase in all cases of syphilis infection and particularly perinatal syphilis where a mother who is infected with syphilis can pass it to her baby. We've seen over a 30 percent increase in congenital syphilis cases in the last several years.

• Ali Rogin:

  And things were going so well. As we mentioned in 2012, cases were at a historic low and now they've increased. So how did things go so wrong?

• Dr. Irene Stafford:

  I believe that partially we are not being vigilant about screening and treating pregnant women. Unfortunately, according to the CDC data, about 30 percent of women don't have access to care. On top of that, there's been a certain percentage that have actually been screened for syphilis but did not get timely treatment. And lastly, there's been a surge in cases where women have converted and become infected with syphilis during the third trimester.

• Ali Rogin:

  And if it's not, what are the symptoms? What are the consequences of not treating congenital syphilis?

• Dr. Irene Stafford:

  Well, unfortunately, the infection itself during pregnancy carries a 30 percent to 40 percent perinatal loss rate. If the baby does survive during the pregnancy and is born with congenital syphilis, sadly, the baby will be in the neonatal intensive care unit for over a week, in some cases longer. The baby can have blood problems, liver problems, bone problems.

  And probably one of the biggest consequences is when the infection itself affects the central nervous system or the brain of the newborn. That can lead to neurosyphilis, which is quite detrimental and hard on a newborn baby and the family, of course.

• Ali Rogin:

  So you're seeing these patients every day once somebody comes in for treatment for a syphilis diagnosis. What does that look like?

• Dr. Irene Stafford:

  My responsibility, and I think the responsibility of most health providers is actually to counsel the patient, talk to her about the need for treatment, oftentimes with syphilis, especially when it's been there for a long time, that level of infection and stage of infection requires multiple doses of penicillin. So the counseling component is critical to help patients understand the need for continued surveillance and follow up so that we can treat her adequately for her stage of infection.

• Ali Rogin:

  And what about the role of COVID-19? We saw lots of resources being reallocated to account for COVID. Was congenital syphilis part of that reallocation of resources?

• Dr. Irene Stafford:

  Absolutely. We did everything we could to reduce contact for patients to reduce the spread of COVID-19, but unfortunately, that alienated a lot of patients. Their favorite clinic on the corner of, say, broad and fifth closed, they didn't know where they could go. So those kind of changes in the actual structure of healthcare really impacted STI screening, especially for infections like syphilis that can often be asymptomatic. Not all patients have complaints. It can be a rash that people think might be eczema and so forth. So oftentimes they don't bring that to the physician's attention, and definitely not when they're not face to face with a physician.

• Ali Rogin:

  So what can people be doing to protect themselves from getting and transmitting congenital syphilis?

• Dr. Irene Stafford:

  I think to begin with, physicians, providers, everyone out there needs to actually start prioritizing sexual health. I mean, this is a call to action. The CDC just came out with a statement that it is time for us to use every resource we can to help encourage patients, regardless of risk factors, to get screened and treated for STI.

  In addition, patients need to self-advocate. Ad if they're, you know, at the physician's office, go ahead and talk about sexual health with your provider, especially when you're pregnant. If you're concerned about syphilis infection, use protection. We've seen in the data that people are using condoms, unfortunately less and less to protect themselves from STI.

• Ali Rogin:

  Dr. Irene Stafford with UT Health, Houston. Thank you so much for your time.

• Dr. Irene Stafford:

  Thank you for having me.