For years, syphilis seemed to disappear from the United States and from Oklahoma. But its return and ensuing surge have created a tragic pattern: a rise in babies born with the infection.
There was a nationwide syphilis pandemic in the 1940s. Through improved treatment and prevention, case counts dropped to just a few thousand nationwide a year. The disease — known as the ‘great imitator’ because of its ability to present like other infections — had effectively been eradicated.
Jump to now. It’s back, and surging.
Public health officials said until a few years ago, the disease was reported mostly among men having sex with men. But that has shifted, as cases of it began appearing in heterosexual women. From 2014 to 2018, the number of syphilis cases among women grew eight fold in Oklahoma. Heterosexual couples face a unique risk: passing the disease to a child.
From 2018 to 2019, the rate of babies born with the infection nearly doubled.
Because this infection hasn’t been in the public eye, many don’t know how it affects adults or infants. Medical professionals refer to the infection in newborns as congenital syphilis.
"Some of the congenital issues that the baby may have with syphilis are some neurological concerns, sometimes the facial features may be dysmorphic. They may have what they call Hutchinson’s teeth, which when the babies come in, they are a little bit formed differently." Ellen Niemitalo, the clinic manager for the Tulsa Health Department said. "There can be, again, some neurological deficits and neurological differences in those babies, as well as sometimes just musculoskeletal deformities."
The infection can also cause stillbirths.
Tricky to detect and treat
First: Oklahoma isn’t alone. The Centers for Disease Control and Prevention reports that nationwide, the rate of congenital syphilis nearly tripled from 2014 to 2018.
Niemitalo points out that syphilis is especially tricky to detect and treat. Again, the ‘great imitator’ can seem like other infections, presenting with a sore or blister that isn’t too painful. Syphilis does something sneakier, though.
"These symptoms also will go away. It might take one month to three months for those to all go away, but they do," Niemitalo said. "But the infection is still there and eventually it can affect the brain and can affect the eye."
So people who have it might not know to get screened. And their doctors might not think to ask. Remember, syphilis did seem to be gone.
“Syphilis was under the radar for a long time, and so providers, we know they’re not really in the habit of assessing for the symptoms frequently or asking the right types of questions to see if someone was at risk for being exposed for it,” Ivonna Mims, the Sexual Health Nurse Manager for the Oklahoma State Department of Health, said.
The CDC provides guidance on syphilis testing in pregnant people. Mims says other states have passed legislation to require those screenings, but Oklahoma hasn’t.
“There’s not been steps taken to mandate that third trimester and delivery screening in pregnant females,” Mims said. “And so therefore, it’s not getting done consistently.”
All of these factors are in play for women who have access to prenatal care. But, some don’t. Oklahoma has the second-highest rate of uninsured people in the country. Although low-income pregnant people often qualify for Medicaid, they do have to know they qualify and enroll.
Similarly, Oklahoma’s county health departments offer free treatment for syphilis. But residents need to know that before they can seek out those services. County health departments also offer low-cost and sometimes free STD testing.
Oklahoma health officials and partners in the medical field have joined to create a task force exploring the state’s surge in congenital syphilis and barriers to care. Niemitalo and Mims both mentioned it and how critical the work will be.
But the COVID-19 crisis has curtailed many public health initiatives. And like with any other social problems, the pandemic has likely worsened the state’s ongoing issues with syphilis.
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