Rise in Syphilis Has Far-Reaching Effect on U.S. Population
Congenital syphilis up 235%
Syphilis cases have skyrocketed in recent years, and repercussions include a lower quality of life for people affected by the disease.1,2
Centers for Disease Control and Prevention (CDC) preliminary data from 2021 show a 34% increase in syphilis cases among women and a 6% increase in syphilis among newborns. The CDC’s 2020 data show a 235% increase in congenital syphilis from 2016.2,3
A recent study revealed that syphilis causes substantial health losses in adults and children, including those who are born with it. Researchers estimate that each case of syphilis results in a loss in quality-adjusted life years (QALYs) for children and their mothers.1
“The goal of our study was to measure losses in quality of life [related to] syphilis,” says Kyueun Lee, PhD, MS, lead study author and a post-doctoral researcher at the University of Pittsburgh’s Graduate School of Public Health and Public Health Dynamics Lab. “Our estimate can inform other kinds of analyses on the impact of syphilis interventions. Ideally, we want to think about a study that follows syphilis patients over their lifetime, but it’s unethical to follow up on people with syphilis. We use a mathematical modeling approach.”
Until people infected with syphilis receive testing and treatment, they are at risk of severe syphilis. Pregnant women could infect their babies with congenital syphilis.
The mathematical models allow for the fact that some cases of syphilis are missed and progress to severe disease, says Minttu Rönn, PhD, MPH, study co-author and a research scientist in the department of global health and population at the Harvard T. H. Chan School of Public Health.
“Even if syphilis is diagnosed immediately after birth, children can still experience symptoms,” Rönn says. “Low birth weight is an example of a symptom of congenital syphilis.”
Also, exposure to the virus in the womb can lead to developmental issues with the neonate. Children exposed to syphilis are not in as full health as they would be if they had not been exposed.
“Neonatal deaths have the biggest impact,” Lee says. “That’s losing the whole life the baby could have lived. While it’s a very small probability, the impact is huge, and that affects our estimate as well.”
With the increasing trend of syphilis cases in the United States, the study’s findings mean that these year-after-year increases will result in more and more health losses in the United States.
The increases in STIs, including syphilis, were caused by multiple factors — not one single, identifiable cause. “It’s a joint cause of background factors,” Rönn explains. “Funding for sexually transmitted diseases [STDs] has declined in the United States over time, and funding has declined for health departments that do education for syphilis.”
Also, there are possible behavioral changes in the population at large and within communities most affected by STIs. Plus, stigma plays a role, and some people could be afraid to report their sexual behavior to clinicians.
“STDs are still very stigmatized, so how willing are people to talk about their sexual health and sexual practices?” Rönn asks. “For congenital syphilis, prenatal care is something where there are gaps in getting women to access prenatal care and to make sure they’re offered syphilis testing and getting treatment. It’s a manifestation of the healthcare system being fractured that people are falling through the cracks.”
Plus, rising cases of syphilis among men who have sex with men (MSM) can lead to higher prevalence of syphilis among women. There are overlaps in which MSM also have sex with women.
“When you have a wide enough circulation of infection, I would say it’s not just individual behaviors,” Rönn says. “It’s also the system and how well they are able to respond to the challenge when there’s not enough money and not enough people [for testing and contact tracing].”
Another risk for severe outcomes from congenital syphilis is when women access prenatal care late in pregnancy. “How easy it is for women to enroll in Medicaid while pregnant is varied,” Lee says.
Women may seek prenatal care later in the pregnancy when they waited a long time to be enrolled in Medicaid. Plus, they may wait longer for physician appointments, and their own schedules and need for childcare could result in their making prenatal care a lower priority, Lee adds.
Most people believe their healthcare providers are a good source of reliable medical information, but they may not ask them about STIs because they are unaware of the risk these pose to their pregnancy, Rönn says.
Another factor that can influence women’s decisions on pursuing prenatal care is legal risk. For pregnant people who are undocumented, it could seem too risky to seek nonemergency medical care. This could worsen under new abortion bans in states with track records of jailing women for their behaviors during pregnancy.
“Criminalizing any part of your health or body is never good for healthcare in general,” Rönn says. “It can only lead to negative outcomes.”
More studies are needed to see the full effect of criminalization and threats of deportation on pregnant people and their healthcare decisions.
“If there is increased distrust in healthcare providers, that will make people think twice before showing up,” Rönn adds.
REFERENCES
- Lee K, You S, Li Y, et al. Estimation of the lifetime quality-adjusted life years (QALYs) lost due to syphilis acquired in the United States in 2018. Clin Infect Dis 2022 Jun 9;ciac427. doi: 10.1093/cid/ciac427. [Online ahead of print].
- Centers for Disease Control and Prevention. Preliminary 2021 data: Syphilis. Page last reviewed May 23, 2022.
- Centers for Disease Control and Prevention. New data suggest STDs continued to increase during first year of the COVID-19 pandemic. April 12, 2022.
Syphilis cases have skyrocketed in recent years, and repercussions include a lower quality of life for people affected by the disease. CDC preliminary data from 2021 show a 34% increase in syphilis cases among women and a 6% increase in syphilis among newborns. The CDC’s 2020 data show a 235% increase in congenital syphilis from 2016.
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