[Vision2020] Syphilis Killing American babies; Third World Health Care?

[Nicholas Gier]

Huffington Post  <http://www.huffingtonpost.com/>
09/28/2017 05:01 pm ET
Doctors See A Surge In Babies With Syphilis-Associated Birth DefectsPublic
health experts say something has gone terribly wrong with prenatal care in
the U.S. and that babies are paying the price.
By Anna Almendrala <http://www.huffingtonpost.com/author/anna-almendrala>

Last year, over 600 pregnancies in the United States were affected by
syphilis. Of those, 45 babies were either stillborn or dead within the
first month of life, while many others may have been born with serious
defects, some of them irreversible
<https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm>.

While these cases represent a tiny fraction of the approximately 3.9
million births that occurred in the U.S. in 2016, public health experts say
that they’re a sign that something is deeply flawed about prenatal health
care in the country, and that not a single one of these pregnancies needed
to be marred by syphilis, a treatable and preventable sexually transmitted
disease.

“When you have congenital syphilis occurring, it means there has been a
breakdown in the whole medical system ― that these cases are not being
diagnosed until a baby is born, when they should be diagnosed antenatally
or even before then,” said Dr. Amesh Adalja, spokesman for the Infectious
Diseases Society of America and a senior associate at the Johns Hopkins
Center for Health Security. “It’s unfortunate that we’re seeing a
resurgence of a disease that should basically be gone.”

When you have congenital syphilis occurring, it means there has been a
breakdown in the whole medical system.

Syphilis is a bacterial infection that can be treated easily with
antibiotics, but can cause sores, rashes, dementia and blindness if left
untreated. In addition to causing miscarriages and stillbirths, babies who
contract it in the womb can be born blind, deaf, or have deformed bones,
skin rashes and enlarged livers and spleens.

It was on the brink of extinction in the U.S. just 10 years ago, but today
is surging. Cases of congenital syphilis, which is when a fetus contracts
an infection from the mother in the womb, rose 28 percent last year ― from
492 in 2015 to 628 in 2016.

The spike mirrors a record high number of STDs in the U.S. in general.
Officials recorded more than two million cases of chlamydia, gonorrhea and
syphilis last year (although officials estimate the true number is around
ten times as much) and young people made up the bulk of the infections. For
syphilis specifically, of which there were 28,000 reported cases, rates
among women increased by 36 percent.

“Each case of congenital syphilis is a sentinel event reflecting numerous
missed opportunities for prevention within the public health and health
care system,” said Dr. Sarah Kidd, of the U.S. Centers for Disease Control
and Prevention’s division of STD prevention. “These missed opportunities
can include women who fell out of the system, either due to poverty, a lack
of health insurance or other contributing factors.”

According to the CDC, about half of moms who give birth to babies with
congenital syphilis either had prenatal care late in their pregnancy, or no
prenatal care at all. Fifteen percent of them were initially tested for
syphilis early in pregnancy but then contracted it afterward. Still others
may have tested positive for syphilis but dropped out of prenatal care
before receiving positive results or starting antibiotic treatment.
CDC
Congenital syphilis cases spiked by 28 percent from 2015 to 2016.
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But more broadly, the U.S. is seeing more congenital syphilis cases because
there are more syphilis cases in general ― especially among women of
reproductive age, Adalja points out. Some people may have the bacterial
infection but not have any symptoms, so it’s up to doctors to make STD
testing a routine part of prenatal care.

“We know how to treat these sexually transmitted infections, from chlamydia
to gonorrhea to syphilis,” he said. “But you have to diagnose them in order
to do that, and it has to be done very routinely, the way that some people
get tested for blood pressure.”

Indeed, both the CDC and the American Congress of Obstetricians and
Gynecologists
<https://www.acog.org/About-ACOG/ACOG-Departments/ACOG-Rounds/May-2017/Syphilis-Resurgence>
recommend
that STD testing be a routine part of prenatal care in the first trimester,
and that women who have multiple sexual partners, a partner with STDs or
who live in an area with high rates of syphilis be tested again later on in
the pregnancy <https://www.ncbi.nlm.nih.gov/pubmed/28703731>.

Despite these recommendations, a recent CDC analysis of 2013 data found
that only 85 percent of privately insured women
<https://www.ncbi.nlm.nih.gov/pubmed/28282647> had a syphilis test while
pregnant. Another CDC analysis found that among women who had stillbirths
in 2013, about 35 percent of women on Medicaid and 30 percent of women with
private insurance had no syphilis testing, either during the pregnancy or
at the stillbirth, and that syphilis testing among all women after
stillbirth was less than 10 percent, suggesting that stillbirths caused by
congenital syphilis could be underreported
<https://www.ncbi.nlm.nih.gov/pubmed/28876321>.

Improving access to maternal care for the poorest and most vulnerable women
in the U.S. would help close some of these gaps in care, but Adalja points
out that shame, fear and misunderstanding about STDs are still major
medical barriers, even for doctors who may decide not to test a prenatal
patient for STDs because she doesn’t “seem” at risk.

“Physicians have to be more in tune to the risks of syphilis and realize
this hasn’t gone away,” he said.
A society grows great when old men plant trees whose shade they know they
shall never sit in.

-Greek proverb

“Enlightenment is man’s emergence from his self-imposed immaturity.
Immaturity is the inability to use one’s understanding without guidance
from another. This immaturity is self- imposed when its cause lies not in
lack of understanding, but in lack of resolve and courage to use it without
guidance from another. Sapere Aude! ‘Have courage to use your own
understand-ing!—that is the motto of enlightenment.

--Immanuel Kant
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