Syphilis Rates Among Women, Infants Have Declined Since 1997, CDC Says

The rate of babies born with congenital syphilis in 2000 dropped 51% from 1997, the year before the CDC began the National Syphilis Elimination Plan, intended to reduce disease rates in adults, according to a nationwide CDC study published in the July 13 issue of Morbidity and Mortality Weekly Report. In 2000, 529 children were born with CS (13.4 cases per 100,000 live births), compared to 1,077 children in 1997 (27.8 cases per 100,000 live births). The study also reported a 38% decline in the primary and secondary syphilis rates among women of reproductive age between 15-44, from 3,590 women (6.0 cases per 100,000 women) in 1997, to 2,219 women (3.7 cases per 100,000 women) in 2000. As infants become infected by their mothers during pregnancy or delivery, the rates of CS follow the syphilis trends in women. Women who gave birth in their teens had the highest rate of infected infants (16.0 per 100,000 live births) in 2000, but this statistic represented a 45.5% decrease from 1997 when the rate among this age group was 29.4. The CS rate among infants was highest in the South (18.8), compared to the Midwest (9.1), the Northeast (10.1) and the West (11.8). With the exception of Arkansas and South Carolina, all states reported numbers that met the CDC campaign's 2000 goal of a rate less than 40 per 100,000 live births. Racial/ethnic minority populations were "disproportionately affected" by CS, with a rate of 49.3 per 100,000 among blacks, 22.6 among Hispanics, 13.2 among American Indians/Alaska Natives and 5.9 among Asians/Pacific Islanders, compared with 1.5 among non-Hispanic whites. Decreases in CS were observed among all racial groups with the exception of American Indians/Alaska Natives for whom the rate increased by 20%. Researchers said in an editorial note, "Lack of prenatal care, late or limited prenatal care, and maternal use of illicit drugs are associated with CS. ... Recent trends in U.S. health care delivery may present substantial barriers to early detection and treatment of syphilis in pregnant women, including the growing number of uninsured women, the limited expansion of prenatal care provided by Medicaid managed care and child health insurance programs, and decreased funding of publicly supported clinics, emergency departments and other providers that serve poor, uninsured, racial/ethnic minority women and adolescents" (CDC, Morbidity and Mortality Weekly Report, 7/13).

Treatment & Consequences
If untreated during pregnancy, syphilis can cause the death of up to 40% of infected infants. To improve the health of women and their children, the CDC teamed with state and local partners to implement the elimination campaign in 1998, using "enhanced" surveillance programs to "track the disease and target interventions," improving access to clinic care for those infected and seeking community support to "address social issues contributing to the persistence of the disease." The CDC recommends that all women be tested for syphilis during the early stages of pregnancy. Pregnant women found to be infected can be treated with a single dose of penicillin, "an inexpensive, widely available antibiotic that is effective and safe for both mother and child," Director of the CDC's Center for HIV, STD and TB Prevention Dr. Helene Gayle said (CDC release, 7/12).

Cause for Celebration
The reported declines indicate a successful disease elimination campaign, CDC officials said. "Three years is literally a heartbeat in public health time," Dr. Judith Wasserheit, chief of STD prevention at the CDC, said, adding, "We should all be celebrating the news" (McKenna, Atlanta Journal-Constitution, 7/13). Dr. George Counts, director of the CDC's syphilis elimination activities, added, "The elimination of [CS] is a feasible goal because of the limited number of cases and its highly concentrated geographic distribution" (Patten-Hitt, Reuters Health, 7/12). Los Angeles was the "congenital syphilis capital of the country," in the late 1980s, Los Angeles County Health Department STD Program Director Robert Settlage said, attributing the spread of the disease to "rampant crack cocaine use, which often leads to prostitution to buy drugs." He added, "Fortunately, those days are behind us," noting that the few cases presently found are due to "slips in the health care [system]" (Sutherland, Los Angeles Times, 7/13).

HIV-Positive Women More Likely to Pass Along Syphilis
Infants born to HIV-positive women were 50 times more likely to be born with CS than the average child, a second CDC study published in the June issue of Sexually Transmitted Disease found, Reuters Health reports. Researchers looked at the rate of syphilis infection among 718 HIV-positive women in Texas from 1988 to 1994 when U.S. syphilis rates were the highest since the 1940s, and investigated the CS infection rate of their newborns. They found that of the 18% of HIV-positive women who were also infected with syphilis, approximately 50% passed syphilis to their babies at birth. "Inadequate or nonexistent prenatal care" was the "main factor" separating infected women who passed on the disease from those who did not, the study reports. Seventy-five percent of children whose mothers did not receive proper prenatal care were born with CS, versus 25% whose mothers did receive adequate care (Reuters Health, 7/11).