Congenital syphilis cases are rising nationally

Here's a brief report from my colleague Don Sapatkin who covers public health:

After declining for 14 years, rates of congenital syphilis increased 23% between 2005 and 2008 nationwide, the U.S. Centers for Disease Control and Prevention reported today.

Congenital syphilis is transmitted during pregnancy when infected women are not treated, often because they are not getting prenatal care, where testing is routine. The rise in congenital cases follows even larger recent increases of infectious syphilis among women, the CDC reported: up 38% between 2004 and 2007, and another 36% in 2008, also after years of decline.

The disease is easily treated with penicillin, and rates of primary and secondary (P&S) syphilis – the key infectious stages – are far higher among men, particularly men who have sex with men.

But the jump in reported cases among women concerns public health officials because of the potential for congenital syphilis. About 6 percent of congenital syphilis cases are stillborn, and many others without treatment develop mental retardation, deafness and bone abnormalities.

The vast majority of babies with congenital syphilis nationally were born to black women with syphilis in the South. The most recent percentage increase was similar in the Northeast but based on far fewer cases.

"The increase in the P&S syphilis rate from 1.1 per 100,000 females in 2007 to 1.5 in 2008 might portend a larger increase in the CS [congenital syphilis] rate in 2009 and future years," the researchers concluded in the CDC's Morbidity and Mortality Weekly Report.  "The increase in the CS rate, the substantial burden of P&S syphilis among black women in the South, and the high case-fatality ratio associated with CS require that CS prevention be given high priority in areas with high syphilis morbidity and evidence of heterosexual syphilis transmission."

Philadelphia has already compiled its statistics for 2009. Although the city has too few cases of congenital syphilis – a total of 4  last year – to discern a trend, the number of reported P&S cases among women jumped 238%, to 27 last year, up from 8 in 2008. Women diagnosed with syphilis in Philadelphia are overwhelmingly poor, black and heterosexual.

An Inquirer story last month reported the syphilis trend in Philadelphia, along with another trend: major cuts in state funding for HIV prevention and screening, much of which also serves to reduce transmission of syphilis.