Amid Syphilis Surge, Doctors Call for More Testing During Pregnancy

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The headquarters of the U.S. Food and Drug Administration (FDA) is shown in Silver Spring, Maryland, November 4, 2009.

The nation’s largest coalition of obstetricians issued an urgent warning Thursday calling on doctors to expand testing for syphilis during pregnancy amid a surge of cases in recent years.

The American College of Obstetricians and Gynecologists updated its recommendations, advising a routine blood screening at the first prenatal visit and screenings in the third trimester of pregnancy and at birth. This contrasts with previous recommendations, which called for testing in the third trimester exclusively for individuals living in communities with high syphilis rates and for those at risk of syphilis exposure during pregnancy.

“We’re always trying to create healthier families, and some of the diseases that we can easily diagnose and treat are things that we should prioritize, especially when they can be devastating to a baby,” said Laura E. Riley, chair of the obstetrician coalition’s immunization work group. Riley helped write the guidance.

“Sometimes, it’s difficult to know that you’ve been exposed to syphilis, and it’s not like you can raise your hand and say, ‘I have this, please give me treatment,’ because you may not even know you have it,” said Riley, chair of obstetrics and gynecology at Weill Cornell Medicine in New York.

Rates of syphilis have been skyrocketing, with cases hitting their highest level since the 1950s. Reported syphilis cases increased 80 percent from 2018 to 2022 in the United States, soaring from about 115,000 cases to more than 207,000, according to the Centers for Disease Control and Prevention.

In 2022, more than 3,700 babies were born with syphilis, with 231 stillbirths and 51 infant deaths attributed to transmission of syphilis from pregnant people to their babies.

Experts say these rising numbers reflect decreased condom use and an uptick in substance use, The Washington Post reported.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. When a pregnant person is infected with syphilis, the infection can pose severe consequences for the pregnant individual and the unborn baby. Left untreated, syphilis can progress to advanced stages and damage organs and nerves.

It can also be transmitted to the fetus during pregnancy or at childbirth, resulting in congenital syphilis, which can lead to severe health problems for the baby, including premature birth, low birth weight, stillbirth, developmental delays and other complications.

Nicole Smith, medical director of maternal-fetal medicine at Brigham and Women’s Hospital in Boston, said that by calling for routine syphilis testing, the guidelines should prove to be a useful tool for physicians, especially when stigma surrounding sexually transmitted infections persists.

“Some populations are less likely to be either screened or treated … due to the locations where they’re receiving care or because there’s a concern among that population that they’re being stigmatized because they’re being tested,” Smith said.

“So if we say, ‘No, this is nothing about you in particular, this is something that we’re doing for every single pregnant person in this country … we’re treating everyone the same way,’ and therefore some of the barriers to appropriate treatment should be diminished or ideally removed,” she said.

A single injection of a long-acting dose of penicillin can cure early-stage syphilis.

If a person has late-latent syphilis or does not know how long they had the infection, the CDC suggests three doses of long-acting benzathine penicillin G, given weekly. While the treatment can eliminate the infection and stop more harm, it can’t undo damage that has already occurred.

Hurdles exist for syphilis patients, including getting access to testing and medication. Drug shortages – a long-standing issue for many medications – have contributed to rising syphilis cases, experts say.

In April 2023, the Food and Drug Administration announced a shortage of penicillin in the United States attributed to increased demand.

To combat the ongoing shortages, the FDA granted temporary approval for a French drug, Extencilline, which is used for syphilis treatment but is not FDA-approved. While the Food, Drug, and Cosmetic Act prohibits importing unapproved drugs into the United States, the secretary of Health and Human Services can authorize temporary importation and distribution of such drugs to address shortages until domestic production returns to normal levels.

Riley said the updated guidance from the obstetricians group is essential because it makes physicians aware of the alternative treatment for syphilis amid the shortage.

In June 2023, the maker of penicillin, Pfizer, said it would prioritize making the drug available, with the shortage expected to be relieved within the next few months of this year.