Feds eye Texas as cases of syphilis surge in newborns

Syphilis is on the rise in Texas and nationally, causing serious medical complications, especially for newborn babies who contract the disease during pregnancy.

Assistant Secretary of Health Dr. Rachel Levine visited Parkland Hospital, Dallas County's public hospital, to discuss the rise of syphilis and what can be done to prevent its spread.

Though often thought to be a disease of the past, syphilis rates have grown consistently in the last decade. Between 2018 and 2022, syphilis cases jumped nearly 80% nationwide, while cases of congenital syphilis—or babies born with syphilis—nearly tripled, climbing 183%, according to recent Centers for Disease Control and Prevention data.

Texas saw 15.5 cases of syphilis per 100,000 people in 2022, putting it below the national average of 17.7. For congenital syphilis, Texas ranked fourth highest among reporting states, with nearly 247 cases per 100,000 live births, more than double the national average.

But a decade earlier, Texas had 6.6 cases of syphilis per 100,000 people and 19.4 cases of congenital syphilis per live births, according to the CDC.

"This is a treatable bacterial illness. Almost all cases of congenital syphilis, again, which is devastating, are preventable," Levine said. "We need, from a public health point of view both locally, statewide and federally, to be addressing this issue."

The rise of syphilis is likely due to a confluence of factors, including increased barriers to health care, which disproportionately impact Black and Brown communities. The disease is also tricky to identify. Early symptoms include a painless sore or rash that goes away whether or not someone receives treatment.

Dr. Emily Adhikari, director of perinatal infectious diseases for Parkland Health, said she rarely saw maternal or congenital syphilis cases while she was training in the early 2010s.

"It has not been rare for any of the trainees that I now train," Adhikari said. "With the public awareness of syphilis as being a problem, I think we're playing catch-up."

Doctors can cure syphilis with an injection of antibiotic penicillin. Without treatment, however, the bacterial infection can spread to the brain, nervous system, eyes or ears. For pregnant women with the disease, their babies can develop cataracts, deafness, seizures and can even die.

The specific penicillin used to treat syphilis is in short supply because of increased demand, leaving health systems in a lurch as they wait for the shortage to wane in the next few months. Parkland pharmacists have had to save doses specifically for expecting mothers and newborns. Doxycycline, another antibiotic, has been recommended for non-pregnant patients to treat syphilis.

Public health professionals consider syphilis to be syndemic with HIV and hepatitis, meaning that they often occur at the same time and carry similar societal risk factors. Syphilis patients may also have mental health concerns or substance use disorders, making their care more complex.

Texas physicians are required to test pregnant patients for syphilis three times so they can catch infections early. But some patients can't afford prenatal care or avoid it because they are dealing with a substance use disorder.

Addressing the social needs of patients and expanding health care options is key to addressing the rise in congenital syphilis rates, said Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council. Beginning March 1, Medicaid and CHIP postpartum coverage will extend from two months after birth to a year.

"If we could put the same focus on prenatal care, maybe some of the things you just heard, we could intervene earlier on, and we could get good results," Love said.

As part of her visit, Levine also met with The Resource Center, an LGBT information hub and advocacy group in Dallas, and Prism Health North Texas, which runs health centers in the area focused on HIV and AIDS services.

"We have seen a steady increase in syphilis cases each year since the end of the COVID-19 shutdown," said Prism CEO Dr. John Carlo. "Many cases have been in our established patients who are also living with HIV, but we are also seeing more cases in new patients coming in, often for treatment of other sexually transmitted infections like chlamydia and gonorrhea."

The slogan "Know your status," often used in campaigns to increase HIV testing, should now include syphilis, said Adhikari, who is also an assistant professor in the Department of Obstetrics and Gynecology at UT Southwestern Medical Center.

"Our HIV outreach team goes to community areas, goes to individuals in the community, where they're at, and offers free HIV testing," Adhikari said. "That is going to be now inclusive of syphilis testing. HIV and syphilis need to go hand in hand."

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