There was a 143% increase in babies born with syphilis in Alabama; Here’s why

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DOTHAN, Ala. (WDHN) — The number of babies born with congenital syphilis continued to rise in 2020, according to the Alabama Department of Public Health.

Last year, 20 babies were born with the bacterial infection, having inherited the disease from their mothers while in the womb. This resulted in a 143 percent increase in congenital syphilis cases from 2019’s case number.

Dr. Agnes Oberkor, congenital syphilis coordinator for the ADPH STD Division, said there were three factors that caused the rise in infant syphilis cases.

“Mistesting during pregnancy, inadequate treatment is the majority; that’s about 75 percent of what we have,” Oberkor said. “That’s 15.”

Aside from these 15 cases, two happened because the mothers got their tests too late for proper treatment. Three other children were born with syphilis because their mothers did not get prenatal care at all.

Oberkor said one of those three mothers could not get prenatal care due to the COVID-19 pandemic.

So who’s being most affected by syphilis?

The rise in cases continues an increasing trend seen in the past decade. In 2013, Alabama only reported two congenital syphilis cases.

Oberkor said syphilis has affected particular ethnicities more than others. An analysis of the ADPH’s STD reports shows that from 2017 to 2020, Black Alabamians made up the bulk of new syphilis cases.

In 2020, Black Alabamians made up 64.1 percent of newly diagnosed primary and secondary syphilis cases, 68.2 percent of early latent syphilis cases, and 68.9 percent of late syphilis cases.

Palmar lesions, sores found on the hands during the secondary stage of syphilis infection (Source: CDC)

According to the latest online census data, 27.8 percent of Alabamans were black in 2019, showing a disproportionate prevalence of syphilis in the black community.

Oberkor said it is not known where Alabama currently ranks in its number of congenital syphilis cases compared to the rest of the nation.

“We can only compare Alabama to the nation with 2018 data,” she said. “Because of COVID-19, we just submitted the 2019 report to CDC, and we have not submitted the 2020 report yet so looking at 2018, Alabama ranked 25 in the nation, and that was when we reported only seven cases.”

Oberkor did say with the rise in cases, Alabama could be closer to leading the nation in the number of congenital syphilis cases.

What happens if my baby is born with syphilis?

While syphilis may take 10 to 30 years before it can cause severe or fatal damage to an adult, Oberkor said a child both in and out of the womb can suffer numerous disabilities or even death if not even death.

Syphilis can cause several issues during pregnancy, including miscarriages, premature births, stillbirths, low birth weight, or death shortly after birth. The Centers for Disease Control and Prevention report that up to 40 percent of pregnant women with untreated syphilis will have their children be stillborn or die shortly after birth.

Treponema pallidum, the bacteria that causes syphilis infections (Source: CDC)

“In 2019, we had stillbirth, one stillbirth, one prenatal death, and we had a preterm delivery, in which the baby also died,” Oberkor said.

If the child survives, untreated syphilis can cause numerous deformities or health conditions that will follow the child for the rest of their life. Even if the child is born without symptoms, they could emerge later.

These conditions include:

  • Deformed bones,
  • Severe anemia
  • Enlarged liver and spleen,
  • Jaundice (yellowing of the skin or eyes),
  • Issues with the central nervous system (the brain and spinal cord)
  • Meningitis
  • Skin rashes

“If it’s not treated early during the first few months of life, then congenital syphilis will continue to manifest in a child, and after two years, you can see teeth damaging in what we call the Hutchinson’s teeth,” Oberkor said. “They will also develop mental delays, intellectual disabilities.”

She said the bacteria can also cause a condition known as saddle nose, in which the nose bridge has a collapse in its cartilage tissue. This can cause breathing difficulties.

“Damages caused by the bacteria (are) not reversible so you have an innocent child come into the world with a deformity that could have been prevented if the mother was treated earlier, before delivery,” Oberkor said.

She said expectant mothers must be vigilant to protect themselves from infection before and during pregnancy.

What do I need to do protect my child from congenital syphilis?

Despite its potentially devastating effects on infants, Oberkor congenital syphilis is easily preventable.

With the rise in congenital syphilis in Alabama, the ADPH is telling doctors to consider all pregnant women at risk for syphilis and to test them during the first prenatal visit, at 28 to 32 weeks into the pregnancy, and during delivery.

“We want pregnant women to be very proactive and also request, if the doctor is not testing them, they should request that they get a test during their first visit to the doctor and also during that 28 to 32 weeks of pregnancy,” Oberkor said.

Oberkor said 15 of the 20 congenital syphilis seen in 2020 could have been prevented if the mothers were tested in the middle of their pregnancy. She also said waiting until a month before birth could be too late for a test.

If a mother tests positive, treatment must be done at least 30 days before delivery to prevent the infection passing on the child after birth. Pregnant women are usually given benzathine penicillin to purge the bacteria from the system, although the amount varies depending on the stage of the mother’s infection.

Oberkor also said the responsibility for the child’s health falls to the fathers since they could infect the mothers during pregnancy, rendering a negative test useless.

While private providers can test for STDs, the Alabama Department of Public Health provides free testing for those who need it.

The Houston County Health Department offers a limited number of tests for residents. You can call 334-678-2800 for information on the next available clinic.

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