Kids at risk
Cases of syphilis in newborns up dramatically during pandemic
Fifteen months ago, Solidad Odunuga received a phone call from the Houston Health Department. Odunuga’s daughter, who had been living on and off the streets, had given birth to a baby boy named Emmanuel before leaving the hospital with no contact information or forwarding address.
Emmanuel was born with congenital syphilis, an infection passed to him during pregnancy from his mother. Odunuga suspects her daughter didn’t know she had syphilis.
“Once she found out, and I found out, there was no more education from that point,” Odunuga said. “Even from the hospital when she was leaving. No pamphlets, nothing to take with her. She had a social worker who was going to give her information, but somehow that fell through the cracks. They just let her go.”
Texas law requires pregnant women to be tested for syphilis, HIV and hepatitis B at their first prenatal visit and again in the third trimester. When a mother or newborn is diagnosed with syphilis, their recovery depends on posttreatment surveillance for up to 15 months afterward, according to a Harris County study conducted by
the Society for Fetal-Maternal Medicine.
Syphilis is curable, and if it is caught early enough and treated with penicillin during pregnancy, the baby can be cured with no problems, said Dr. Irene Stafford, a maternal-fetal specialist and associate professor at UTHealth’s McGovern Medical School.
But many women, like Odunuga’s daughter, do not attend regular prenatal visits. Without information, education and outreach, infected people are often untreated and unaware of the long-term consequences of their infection, Stafford added.
In late July, Odunuga’s daughter gave birth to a second child with congenital syphilis. Again, she was not given options, information or guidance before she left the hospital on foot, Odunuga said.
That was about a month ago. Now Odunuga, 48, has quit her job to care for her two grandchildren, each suffering the long-term effects of syphilis. One doctor told her Emmanuel would never walk; another said he would be developmentally delayed.
“There were a lot of developmental issues from the beginning with feeding and eating, and we’re still dealing with all those same things as of today,” Odunuga said. “He has about seven or eight different illnesses that have stemmed from all this.”
Though treatable, syphilis still a problem
Emmanuel is considered one of the lucky ones because he survived delivery. More babies are born with congenital syphilis in the Houston area than any other part of the state.
Infected fetuses often die in utero, or the baby dies soon after birth, said Lupita Thornton, a public health investigation manager for the bureau of HIV/STD and viral hepatitis at the Houston Health Department. If they do survive delivery, their symptoms can mirror diaper rash or a cold, but on the inside, their organs and bones are damaged.
In April, the department reported a marked increase in fetal deaths linked to congenital syphilis during the pandemic, up from four in 2019 to 14 in 2020 — an increase of 250 percent. Since 2019, all fetal deaths linked to syphilis in Harris County were among either Black or Latino fetuses, according to the department. That year, the Centers for Disease Control and Prevention reported 1,870 cases of congenital syphilis across the U.S.
Stafford works with Odunuga and others in the heart-wrenching position of caring for young children born with syphilis. Forty percent of congenital syphilis cases end in stillbirth or death after delivery, Stafford said. What makes her upset is that these deaths are “100 percent preventable.”
“It’s a sea of lost people, including (Odunuga’s) daughter, who don’t get follow-up treatments and intervention,” she said.
“Young ladies and women are lost, and they don’t know where to go,” Stafford said. “Whether they know they’re pregnant or they’re late to care, they have no idea how to get plugged in. They don’t know how to get tested. It’s a community problem — a systemic issue for outreach and education for young people.”
Syphilis symptoms are hard to decipher because the infection can go dormant in adults after an initial breakout or rash, Thornton said. If left untreated, the infection can cause body rashes, sores and alopecia in the first and second stages. Later, it can cause severe, irreversible damage to the heart and brain, she added.
“A lot of people may think ‘Maybe I just changed my detergent and I’m allergic to it,’ ” Thornton said. “If it’s a penile lesion, men will think it’s a zipper cut. Women maybe can’t see the actual primary lesion because it’s in the cervix or inside the mouth. It doesn’t hurt, so you’re not aware of it.”
Syphilis has risen in women and heterosexual couples, she added. When that happens, there is often a correlation in babies born with the infections.
“We don’t know what happens with the children in the long run — maybe attention deficit disorder or learning disabilities, but we don’t know. We need more surveillance and studies for that,” Thornton said.
A prenatal promise
The rise in Houston-area cases prompted the health department to create an outreach team, providing women of childbearing age with information on HIV/AIDS and syphilis. The two infections often rise simultaneously in Houston, she said.
The team started “My Prenatal Promise” — at MyPrenatalPromise.com — a campaign that urges pregnant women, especially women of color, to be tested for syphilis at least three times.
When a patient tests positive for syphilis during pregnancy, the health department is alerted and attempts to schedule follow-up talks with the patient’s primary doctor — if they have one — to make sure a treatment plan is underway.
If the person is childbearing age and tests positive, the team checks in with them periodically to make sure they are being treated in case they become pregnant after diagnosis.
The newly formed team has also worked to treat spouses, so there’s a lower risk of reinfection, Thornton said. Prior to delivery, neonatal physicians and nurses are informed about the possibility for congenital syphilis so medications are on hand as soon as the baby is delivered.
A burden on women of color
In Katy, Odunuga’s day starts at 5 a.m. when her grandson, Emmanuel, wakes up.
Two hours later, she drops him off at Joycare Pediatric Day Health Center for physical and speech therapy sessions until midafternoon. When they get home, she feeds him and entertains him until his 7 p.m. bedtime.
But then there’s the night rotation of waking up when he cries. Emmanuel has asthma and allergies, and has suffered from seizures on a routine basis.
The days never seem to end, Odunuga said, especially now that she and her oldest daughter are caring for the newborn, as well.
“My daughter is helping me watch the babies. I can’t do two of them,” she said.
Congenital syphilis is disproportionately affecting Black and Hispanic patients, said Stafford, a maternal-fetal specialist. If the patient is low income or experiencing homelessness, it’s difficult to track and trace their points of contact, even if they are diagnosed early. It’s even harder to bring them back in for timely treatment, she said.
Funding for tracking and tracing sexually transmitted infections (STI) has been affected by COVID-19, as well. At some health departments, contact tracers have been diverted to handle the pandemic’s spread.
“Fundamentally, we need to consider that STIs will never really go away. Not paying attention to them is only going to make them worse,” she said. “At this point, if we’re having a baby pass away more than once a month from something preventable, we have an obligation as a city to make this a known public problem.”
Stafford hopes for more community outreach by local health departments, hospitals, public and private health care providers and social media platforms. People need to know where to go for testing and how to find well-timed treatment, she said.
“People think it’s been eradicated because people don’t know,” Stafford said. “With every patient I see at almost every visit, I want them to be tested for STI’s — it’s not about stigma or embarrassment.
“I know you’re having sex, this isn’t your fault. Let’s get on top of it and get you tested.”