One of the country's most preventable diseases is killing newborns in ever-increasing numbers.
Across the country, 1,306 children were acquired syphilis by 2018, an increase of 40% compared to 2017, according to federal data released Tuesday. Seventy-eight of these babies were stillborn and 16 died after birth.
In California, cases of congenital syphilis – the term used when the infection is transmitted to a baby during pregnancy – continued a steep seven-year rise. There were 332 cases in the state in 2018, up 18.1 percent from 2017, according to federal data.
Only Texas, Nevada, Louisiana and Arizona had congenital syphilis rates higher than California, which was 67.9 cases per 100,000 live births. (The highest rate was in Texas, where there were 92.2 cases per 100,000 live births.) Combined, these five states made up nearly two-thirds of all cases, although all but 17 states saw increases in birth rates. congenital syphilis.
State-by-state figures were released as part of a larger report by the Centers for Disease Control and Prevention. tracking trends in sexually transmitted diseases. National syphilis cases, gonorrhea and chlamydia the combined reached a historical high in 2018. Cases of the most infectious stage of syphilis increased by 14% to over 35,000 cases; gonorrhea increased by 5% to more than 580,000 cases; and chlamydia increased 3% to over 1.7 million cases.
For veteran public health workers, the upward trend in numbers of congenital syphilis is particularly disturbing because the condition is so easy to prevent. Blood tests can identify infections in pregnant people. The treatment is relatively simple and effective. When caught during pregnancy, transmission to the baby can usually be interrupted.
"When we see a case of congenital syphilis, it's a hallmark of a healthcare system and a health failure," he said. Virginia Bowen, a CDC epidemiologist and author of the new report.
Only a few doses of antibiotics are needed to prevent syphilis transmission during pregnancy. Left untreated, Treponema pallidum, the corkscrew-like organism that causes syphilis, can move through the placenta and enter the fetus. Once there, it can multiply furiously, invading all parts of the body.
The effects can be devastating. Dr. Philip Cheng is a neonatologist at St. Joseph's Medical Center in Stockton. The brain of one of his patients did not develop properly and the baby died soon after birth. Other young patients survive but fight blood abnormalities, bone deformities and organ damage. Congenital syphilis can cause blindness and excruciating pain.
California Central Valley's public health departments, a largely rural extension, report similar experiences. By 2018, syphilis, gonorrhea and chlamydia reached their highest levels in 30 years, according to state data released Tuesday. The California Department of Public Health has attributed 22 stillbirths or neonatal deaths to congenital syphilis.
In recent years, Fresno County, which had 60 cases of congenital syphilis in 2017, has had the highest rate in California. In 2018, Fresno came in fourth, behind the counties of Yuba, Kern and San Joaquin. But the epidemic is far from being controlled.
"I couldn't even tell how soon we will see a fall," said Jena Adams, who oversees Fresno's HIV and STD programs.
Syphilis was once a prolific and widely feared STD. But in the 1940s, penicillin It has been found to have an almost perfect cure rate for the disease. In 2000, syphilis rates were so low in the US that the federal government launched a plan to eliminate the disease. Today that goal is a distant memory.
Health departments tracked all people who tested positive for chlamydia, gonorrhea or syphilis to ensure they and their partners received treatment. With limited funds and escalation cases, many states now devote resources only to syphilis tracking. The number of cases is so high in some California counties that they track only women of childbearing age or only pregnant women.
"Much of the funding for daily public health work does not exist," he said. Dr. Jeffrey Klausner, a UCLA professor who has directed the San Francisco STD program for over a decade.
Most STD prevention funding is directed by Congress to the CDC, which passes it on to states. This funding has been very stable since 2003, according to data from the National Coalition of STD Directors, which represents health departments across the country. Take inflation and the increasing number of cases into account, and money spreads more. "It takes money, training, resources," Klausner said, "and policymakers just didn't prioritize that."
San Joaquin County health authorities have reorganized their department and requested donations to increase the number of investigators available as congenital syphilis has increased, said Hemal Parikh, the county's STD control coordinator. But even with new hires and reducing screening for only women of childbearing age with syphilis, an investigator may have 20 to 30 cases open at a time. In other municipalities, the number of cases may be double that.
In 2018, Jennifer Wagman, a UCLA professor who studies infectious diseases and gender inequality, was part of a group that received funding from the CDC to analyze what is causing the rise in congenital syphilis in California's Central Valley.
Wagman said that after years of studying health systems in other countries, she was shocked to see how much basic public health infrastructure had collapsed in California. In many parts of Central Valley, specialist clinics testing and treating sexually transmitted diseases were closed after the recession. This left few places for care and investigators with no place to take someone for immediate treatment.
California's most challenging cases end with the state's growing housing crisis and a methamphetamine epidemic with few treatment options. Homeless women often have unreliable contact information and are unlikely to have a primary care physician. This makes them difficult to track down to make a positive diagnosis or follow a treatment plan.
Louisiana had the highest rate of congenital syphilis in the country for several years – until 2018, when it dropped 22 percent, to 72.8 cases per 100.00 live births. Louisiana is now behind Texas and Nevada. (The State of Silver had 85.5 cases per 100,000 live births last year.)
The fall in Louisiana is the direct result of $ 550 million in temporary supplemental funding that the CDC has given the state to fight the epidemic, said Chaquetta Johnson, deputy director of operations for the state's STD / HIV / hepatitis program. The money helped to strengthen the state's public health infrastructure. It was used to hire two case managers and a nurse educator, create a home treatment program, and improve data systems to track cases, among other things.
In California, over 40% of pregnant women with syphilis transmitted it to their baby in 2016, the most recent year for which data are available. Gavin Newsom has made additional funds available this year, but it is a "drop in the bucket," Sergio Morales said of Access essential health, a nonprofit organization that focuses on sexual and reproductive health and is working with Kern County on congenital syphilis.
"We are seeing the results of years of inaction and lack of prioritization of STD prevention," he said, "and now we are paying the price."