Doctors look to slow congenital syphilis
Health Department efforts stymied by loss of funds as cases keep rising
Houston physicians are looking for new ways to address the rapidly growing number of congenital syphilis cases at the local and national level, as public health officials grapple with funding woes.
The Houston Health Department, which declared a local syphilis outbreak last year, lost about $4.2 million of grant funding from the Centers for
Disease Control and Prevention as a result of the federal debt ceiling deal. The money was intended for states and local jurisdictions to train and hire additional disease intervention specialists.
“It certainly makes it difficult,” said Lupita Thornton, a public health investigator manager at the Houston Health Department.
“We will have to try to find money somewhere else to be able to keep the staff that we have, and we’re not going to be able to add any more personnel, as we had planned.”
Nationally, the rise of congenital syphilis does not appear to be slowing. A CDC report published in November said 3,761 cases of congenital syphilis were identified in the U.S. in 2022, an increase from the 2,865 cases reported the previous year. A lack of timely testing and adequate treatment during pregnancy contributed to nearly 90 percent of the 2022 cases, the report said.
More than 37 percent of infants with congenital syphilis were born to people who had received no prenatal care, the report said.
“If (pregnant patients) come in and get tested, they’re not coming back for treatment,” said Dr. Irene Stafford, a maternal-fetal specialist and associate professor at UTHealth Houston’s Mc
Govern Medical School. “Even if they get tested and come back for the first treatment, they’re not necessarily coming back to complete treatment. So it’s an access to care issue.”
Blow to public health
Syphilis is a sexually transmitted disease that can cause small, usually painless sores that heal on their own, even if the person is still infected. The disease can be cured with penicillin, but left untreated, it can develop in stages. Pregnant women can pass it on to their baby, potentially leading to a stillbirth. Babies who survive might develop deformed bones, an enlarged liver and spleen, meningitis, skin rashes and severe nerve damage that affects their sight and hearing. Many babies don’t have immediate symptoms but can experience problems years later.
Texas accounts for nearly a quarter of all congenital syphilis cases in the nation, reporting 680 in 2021. The state, which has the highest percentage of uninsured residents in the U.S., also had the fourth-highest rate of congenital syphilis in the country that year.
The Texas Department of State Health Services had expected to receive about $93 million from the CDC’s five-year STD intervention grant to shore up their response. But the final two years of funding was slashed for all jurisdictions, with Texas losing about $37 million.
Now, it’s unclear whether Texas can keep its grant-funded staff beyond 2024. The state used the money to hire about 180 STD intervention specialists in 2021. In Houston, the money would have helped retain about 20 full-time workers.
“Public health won’t be able to follow up on as many cases unless there is another funding source,” said DSHS spokesperson Chris Van Deusen. “It could lead to a decrease in testing and treatment and the opportunity to prevent future disease cases.”
Different solutions
As public health departments work to control the spread of the disease, physicians like Stafford look for other ways to fill gaps in testing and treatment.
She’s on the front line of the issue as the leader of the perinatal syphilis program at UT Physicians. She recently received a $3.3 million grant to develop a molecular diagnostic test that can better detect whether a baby is infected at birth.
Right now, doctors primarily diagnose congenital syphilis based on a cumbersome algorithm that produces slow results and isn’t always effective. Patients need multiple follow-up tests to definitively rule out an infection. The strategy often leads to delayed or missed treatment, according to the National Institutes of Health.
The new test “could change the game tremendously,” Stafford said.
Texas requires doctors to test pregnant patients for congenital syphilis three times — once in the first and third trimester, and again at delivery. But for many pregnant patients who don’t have insurance or face other barriers, a trip to the emergency room might be the only time they receive prenatal care.
Stafford is pushing for Texas emergency departments to routinely test for syphilis unless the patient opts out. The CDC recommends a similar routine testing strategy for HIV infections. Lyndon B. Johnson and Memorial Hermann hospitals are both considering a adopting pilot program that will implement routine opt-out syphilis testing, as well as rapid testing, Stafford said.
Some hospitals have already made changes. Last year, the Harris Health System created a best practice alert within the electronic health record at Ben Taub and LBJ hospitals, automatically notifying physicians when a patient hasn’t been screened for syphilis at intake or at 28 weeks.
Tailored approaches
While the new hospital initiatives are a positive step, addressing the congenital syphilis problem should not be a one-size-fits-all approach, said Dr. Catherine Eppes, associate professor of obstetrics and gynecology at Baylor College of Medicine. She noted that racial disparities associated with maternal mortality and morbidity in Texas are also evident when it comes to congenital syphilis.
Babies born to Black, Hispanic, or American Indian/Alaska Native mothers were up to eight times more likely to have newborn syphilis in 2021 than babies born to white mothers, according to the CDC. In 2022, inadequate treatment was most common among Black and Hispanic or Latino birth parents, the CDC report said.
It’s important, Eppes said, for community organizations to partner with hospitals to tailor the best approaches.
“I think a lot of effort into the equity aspect of testing and access to care are going to be really important, to make sure that whatever solutions we come up with don’t widen that disparity,” she said.