A Centers for Disease Control and Prevention report released Tuesday has Texas leading the nation for cases of congenital syphilis, with 367 cases, or 92.2 per 100,000 live births.
Local data from the San Antonio Metropolitan Health District shows the reported number of congenital syphilis cases in Bexar County increased 258 percent between 2017 and 2018, from 17 to 61 cases, which the public health department attributed largely to the change in case definition.
The total number of congenital syphilis cases in 2018 includes all babies born to women who have ever had syphilis and had no proof of treatment, said Dr. Anita Kurian, assistant director of communicable diseases at Metro Health. Had the case definition not changed to include these cases, Bexar County would have seen a 47 percent increase, from 17 cases in 2017 to 25 cases in 2018, she said, noting that “even one case is too many” because the disease is highly treatable with penicillin or antibiotics.
Syphilis is a sexually transmitted infection that presents in four stages with different signs and symptoms associated with each stage. Sores around the infection site show up in the primary stage, and in the secondary stage, a person might develop a rash or swollen lymph nodes. If left untreated, the disease eventually damages the person’s internal organs and can result in death.
Congenital syphilis occurs when a mother with syphilis passes the infection on to her baby during pregnancy, which can cause deformed bones, brain and nerve problems, and severe anemia in children.
As of Sept. 1, Texas physicians are required to test pregnant women for syphilis three times: at the first prenatal visit, during the third trimester (no sooner than the 28th week), and at delivery. Previously, state law required testing at the first visit and during the third trimester. If testing was not performed during the third trimester, or could not be verified, testing was required at delivery.
Dr. Doug Curran, who relinquished his role as president of the Texas Medical Association in May 2019, said routine screening for syphilis in women during and after pregnancy “has been going on for some time,” and has been long considered best practices in the medical community.
“The medical community has been well ahead of the curve when it comes to diagnosing and treating syphilis. The real point of additional reporting is to help communities figure out what the missed opportunities are when it comes to getting people into treatment,” Curran said.
Since 2013, Metro Health’s Healthy Beats program has been working to ensure appropriate testing and treatment for syphilis occurs during pregnancy. The initiative was created to address the county’s congenital syphilis rate in 2012, which was 3.4 times higher than the state’s.
Kurian said the program hired a congenital syphilis coordinator to lead the health department’s congenital syphilis case review team that meets on a quarterly basis to “take an in-depth look at the cases.” The group has reviewed 15 cases of congenital syphilis since they began meeting in Nov. 2018.
“[The case review] entails not just extracting medical information, but also interviewing the mom from her perspective to learn what things we could have done better to help her receive treatment,” Kurian said.
While Kurian declined to disclose any findings from the congenital syphilis case reviews ahead of any formal report on the results, she said that women not receiving timely prenatal care and not treating syphilis when diagnosed are known factors contributing to the rates.
Chris Van Deusen, director of media relations at the Texas Department of State Health Services, said that congenital syphilis case reviews showed “competing priorities” have gotten in the way of women accessing treatment for syphilis, including “housing stability, intimate partner violence, [and] substance use.”
The department has syphilis data dating back to 1931, ahead of the disease becoming a nationally reportable condition to the CDC in 1944, Van Deusen said.
Curran said that access to care is the main contributing factor to increasing STD rates in Texas and on a national scale.
“In Texas, 20 percent of our working people don’t have health insurance. That is an enormous number, yet nothing has been done about it in a number of years,” Curran said. “Until we change that, until health care access improves, we aren’t going to see any great improvement in the number of health complications and deaths resulting from curable diseases.”
The recent CDC study shows that 2018 is the fifth consecutive year for an uptick of STDs nationwide.
“I think it’s nice that the state is acknowledging – and the CDC is acknowledging – these diseases and wants to collect the data to figure out how to make it a little better, but I don’t want to give these efforts too much credit,” Curran said “The problem is not with reporting, it’s not with data collection. The problem is with access to care.”