"It’s alarming:" Here's why syphilis, a disease once almost eradicated, has come roaring back

Last week, the Centers for Disease Control and Prevention released a new study that found women giving birth in the U.S. are three times more likely to have syphilis today than they were approximately eight years ago. 

The rise in syphilis has coincided with a spike in congenital syphilis cases, which is when a mother with untreated syphilis passes the infection to her infant. For infants born with congenital syphilis, the effects can be severe and sometimes life-threatening. Specifically, the report found that more than 10,000 women who gave birth in 2022 had syphilis — an increase from 3,400 cases in 2016.

A separate report from the CDC report in January found that nearly 3,800 babies were born with congenital syphilis, a 10-fold increase over the past decade that caused 282 stillbirths and infant deaths in 2022. Unfortunately, the CDC estimates 90 percent of congenital syphilis cases could have been prevented — and it’s not like the U.S. hasn’t been able to drive down syphilis cases before. 

In 2000, syphilis was close to being eliminated. Today, it’s part of the country’s sexually transmitted disease epidemic. According to the CDC, maternal syphilis rates between 2021 and 2022 was highest in South Dakota, which is one state where the case rate has increased more than 400 percent since 2016, followed by Mississippi and Louisiana.

What’s behind the rise in syphilis — and why can’t it be contained? As Salon has reported before, testing is becoming harder to come by for vulnerable populations because free test clinics — including some Planned Parenthood clinics — were defunded by Trump administration policies. But that’s just one part of the story. Salon spoke with Dr. Elizabeth Cherot, president, CEO of March of Dimes, and a practicing OB-GYN, to learn more.

This conversation has been lightly edited and condensed for clarity.

According to a recent CDC study, the number of expecting mothers with syphilis in the United States more than tripled between 2016 and 2022. Can you explain the significance of this?

It’s alarming. As an infection that can cause serious problems, like miscarriage, preterm birth and stillbirth, and we’re falling in the wrong direction. It’s important for pregnant women to get screened and treated right away. When you think about syphilis, it's completely treatable with antibiotics and we should be much better here.

Can you elaborate how doctors test and treat syphilis, and the risks of it going untreated?

The signs and symptoms happen over time. There are different stages of syphilis. But syphilis again is a sexually transmitted disease that you can get through sex and through contact with an infected person’s syphilis sore. Primary syphilis is usually a small, hard, painless, sore. A lot of people don't know that they have it, and it usually develops in the genitalia.

Testing is a two-step process. If you screen negative, you’re fine. If you screen positive, now you have to be confirmed. So that's a process. And if it took a lot to get you in — whether it's, you know, miles to drive, or getting into the clinic — you have to come back for that confirmatory test. And then, if it doesn't get treated, you can go on to have the other stages of syphilis. 

So, secondary syphilis, you'll often see the most common thing that people talk about is having rashes on the palms of your hands and soles of your feet. You used to see that in movies more than you’d see in real life, but now we're really seeing it.

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Then there's the latent stages of syphilis. Even though you don't have signs and symptoms, you're still infected. And this [bacterium] is a spirochete that lives in your body over time. If it's untreated, you can have big issues with neurological symptoms, blindness, damage to internal organs and even your heart.

And then specifically, in the maternal aspect, is that miscarriage can happen, preterm birth can happen, fetal growth restriction, problems with placenta and stillbirth. I remember delivering a baby way back in the ‘90s with congenital syphilis to and they had Hutchinson teeth. Up to 40 percent of babies born to women with untreated syphilis die from their infection.

Syphilis is passed from mom to baby during pregnancy. It can happen during vaginal birth as well. If a baby has direct contact with a sore, that’s called congenital syphilis. Since this increase has been happening, the recommendation is to actually get screened twice during pregnancy; it didn’t used to be that way. 

Right. And the U.S. came close to eradicating syphilis, but rates of the disease began to creep up in the early 2000s and haven’t been able to slow down since. What’s actually driving this rise?

Syphilis is a sexually transmitted infection. And it's preventable. You get syphilis by having direct contact with an infected person's syphilis sore, or chancre. But the thing about getting screened and treated is that you have to come in, and so the barriers to getting high-quality prenatal care are both social and economic factors. Part of the rise is an access issue. 

Like I said, a typical syphilis test is a two-step process. You are screened positive, then you have to be confirmed positive, to get treatment. And that may be two different visits. A lot of this can be attributed to the usual barriers that can be anything from lack of insurance to getting that limited healthcare access. I also think it's the system level barriers and that includes systemic racism. 

And taking a closer look at the data, you can see that for all races and ethnicities syphilis has increased over the last four years. But there is a big increase for American Indians and Alaska Natives. What does this tell us about accessibility and race when it comes to testing and treatment?  

We also know that these are some of the most vulnerable women in our society, who don’t have access to prenatal care, who live in maternity care deserts. In Alaska, they may have to take a plane. 

And we know that the largest increase occurs in women who have no prenatal care, that maternity care deserts have a higher incidence of no prenatal care, and we know Native Americans do as well. So we have a lot to do here, and it highlights more of our maternity care desert report that we put out every year. That really highlights an accessibility issue that we are not prioritizing moms of babies across this country. Women are living in places that don't have providers or hospitals to go to, and I think that really is exactly what you're seeing here. And this is a population we're not addressing.

Throughout this conversation, I've been thinking, ‘This is the impact of maternity care deserts.’ Why are we seeing more of these maternity care deserts in the U.S.? Could you briefly explain?

We’re seeing that hospitals are closing down units because they don't have enough volume because of nursing shortages and provider shortages. And we're not just talking OBGYNs, we’re talking midwives — that low volume, that liability, those are all stacking up against each other. And so it's a business, financial decision when these places close, and it's not really looking at where we need to sustain these places for these women. And the infrastructure of our birthing system isn't helping. 

I thought it was really interesting how, as expected, we saw that the biggest increase in syphilis was seen among those who did not receive prenatal care at all, but it still did increase for expecting mothers who began care in the first trimester. 

I truly think this comes down to timing and testing. You may have gotten screened in the first trimester, but you need to get screened in the second as well or entering the third is really where most people do it, or that's what the recommendation is. I think no testing or testing too late, is really where we're seeing a lot of that.

If you think you have syphilis, talk to your provider right away. I think having an honest and open conversation about getting screened and treated and what that process is, is really important. If anybody needs more information, they can go to Marchofdimes.org.