Did You Know?
• Congenital syphilis rates are increasing nationally.
• After a steady decline from 2008 to 2012, congenital syphilis rates increased sharply in 2014. That year, the Centers for Disease Control and Prevention recorded the highest number of congenital syphilis cases since 2001.
• Congenital syphilis rates decreased from 10.5 to 8.4 cases per 100,000 live births during 2008 to 2012, but then increased to 11.6 cases per 100,000 live births in 2014. The increase coincided with a 22 percent national increase in the rate of primary and secondary syphilis among women during the same period, according to the CDC.
Sexually transmitted disease rates in Clark County are increasing, which is troubling enough to public health officials. But having two babies born with syphilis last year is not only troubling, it’s tragic, said Dr. Alan Melnick, Clark County health officer.
“That is a tragedy that we should be able to prevent,” Melnick said.
After years without any cases, Clark County Public Health reported two cases on congenital syphilis in 2016. Despite the risk of stillbirth, infant death and disability, both Clark County babies appear to be in good health now, Melnick said.
“We haven’t had two cases in one year going back several years,” he said. “This is unusual for us.”
Syphilis is a curable sexually transmitted disease that is passed from person to person through direct contact with a syphilis sore. Many people, however, don’t have symptoms and may not know they have the disease. Without treatment, syphilis may lead to serious health problems, according to the Centers for Disease Control and Prevention.
Congenital syphilis occurs when the baby, in utero, becomes infected with the sexually transmitted disease. Women can become infected during pregnancy or before pregnancy and, left untreated, pass the disease on to the unborn baby.
In infants, syphilis can be fatal. Up to 40 percent of congenital syphilis cases result in stillbirth or infant death. Congenital syphilis can also cause premature birth, low birth weight, deformed bones, blindness, deafness and brain damage that leads to developmental delays, among other problems.
The CDC recommends all pregnant women be tested for syphilis at their first visit. Those at high risk of contracting the disease — such as those with multiple sexual partners or drug users — may require testing again during the third trimester of pregnancy and once the baby is born, Melnick said.
Washington state law requires pregnant women be tested for syphilis.
“Because it’s such a horrible condition, that’s why the CDC recommendations are what they are. That’s why state law requires testing,” Melnick said.
Minimal prenatal care
In Clark County, the mother in one of the two congenital syphilis cases had a negative test in her first trimester; the other wasn’t tested, Melnick said.
In the first case, the mother’s syphilis test came back negative. Several months later, however, public health officials learned through a syphilis case investigation that the woman was a sexual partner to someone who had tested positive for syphilis, Melnick said.
Health officials tracked down the woman, who had very little prenatal care after the first visit. She and the baby were evaluated and treated, Melnick said.
“The baby was evaluated and treated and, as far as I know, is doing well,” he said.
In the second case, the mother had no prenatal care and was not tested for syphilis. She went to the hospital with pelvic pain and tested positive for multiple drugs, as well as syphilis. She and the baby were treated for the disease, and the baby is doing well, Melnick said.
Health officials point to two factors for the increase in congenital syphilis cases: the growing number of syphilis cases and the high-risk population that does not receive prenatal care.
“If we have more syphilis, we’re more likely to have more congenital syphilis,” Melnick said.
The number of cases of chlamydia, gonorrhea and syphilis in Clark County increased from 1,774 cases in 2014 to 2,160 cases in 2016, according to Clark County Public Health data.
Since 2014, Clark County has seen an increase in the proportion of women with gonorrhea and syphilis. The number of women diagnosed with gonorrhea has nearly doubled — from 73 cases in 2014 to 141 cases in 2016 — while syphilis cases in women have jumped from three cases in 2014 to 15 in 2016, according to public health data.
Like syphilis, untreated chlamydia and gonorrhea can lead to complications in pregnancy and birth, Melnick said. But syphilis, he said, is “particularly horrible.”
“We need to ensure that people get adequate prenatal care,” Melnick said. “And we need public health programs to identify and ensure people are treated for sexually transmitted diseases.”
“The more we can do to reduce the disease in the community, the less we’ll see of this,” he added.