The NCSL Blog

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By Charlie Severance-Medaris

Over the last six months, much of the nation’s attention has focused on the newly identified coronavirus that causes COVID-19. However, researchers at the Centers for Disease Control and Prevention (CDC) continue to sound the alarm about new cases of a much older infectious disease—syphilis.

Syphilis is normally spread through sexual contact and can lead to serious complications if left untreated.

Congenital syphilis, which occurs when syphilis infection is passed from a mother to fetus during pregnancy, is especially concerning. Congenital syphilis can cause miscarriage, stillbirth or early infant death, and infected infants can experience lifelong physical and neurologic problems.

New cases of congenital syphilis increased 261% from 2013 to 2018, according to a recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR). While alarming, researchers stress that syphilis is both preventable and treatable if detected early.

Although congenital syphilis is a national concern, researchers identified geographic and racial differences in new cases and barriers to effective screening and treatment. Of new cases in 2018, 52.5% occurred in the South and 35.6% in the West, compared to 7.9% in the Midwest and 4.1% the Northeast. Further, 39.1% of new cases occurred among Black mothers, 31.5% occurred among Hispanic mothers, and 21.9% occurred among white mothers, with 7.6% of new cases occurring among other races/ethnicities.

Nationally, a lack of adequate maternal treatment, despite the timely diagnosis of syphilis during pregnancy, was the most commonly missed prevention opportunity and accounted for 30.7% of new cases of congenital syphilis cases in 2018. The analysis found that the next most commonly missed prevention opportunity was a lack of timely prenatal care, which accounted for 28.2% of new cases.

Commonly missed prevention opportunities in the South mirrored national trends. In the West, the order was flipped—a lack of timely prenatal care was the most common, accounting for 41.1% of new cases—followed by a lack of adequate maternal treatment despite a timely diagnosis. In the Northeast, the most missed prevention opportunity was late identification of syphilis during pregnancy, accounting for 39.6% of new cases.

Researchers also highlighted racial and ethnic disparities in the South, the region hardest hit by new cases. A lack of timely prenatal care was the most commonly missed prevention opportunity among white mothers, whereas among Black and Hispanic mothers, lack of adequate maternal treatment was the most common. In the West, regardless of race or ethnicity, lack of timely prenatal care was the most missed prevention opportunity.

While the national increase and disparities are alarming, syphilis is 100% preventable and easily treatable if detected early. The timely identification and treatment of syphilis in pregnant women can prevent transmission to the baby.

Congenital syphilis prevention involves timely identification and treatment of pregnant women with syphilis, as well as traditional syphilis prevention strategies among women and their partners.

The CDC recommends universal syphilis testing at the first prenatal visit—most, but not all, states have statutes or regulations to require this screening. The CDC also recommends universal screening early in the third trimester and at delivery for areas with high prevalence of syphilis. Several states have taken further measures to require syphilis screening more frequently than in the first trimester.

In 2015, Texas passed SB 1128 requiring syphilis testing in the first and third trimester of pregnancy. In 2019, the state passed SB 748 further expanding testing requirements to include syphilis testing at delivery and creating the Newborn Screening Preservation Account to help cover the costs of expanded testing.

The legislation also requires the Texas Department of Health and Human Services to publish a biannual report on congenital syphilis. Authors of the most recent report state that “it may take up to five years to clinically identify any true increases or decreases” in the state’s congenital syphilis cases as a result of expanded screening.

Michigan also recently updated its screening laws, passing HB 6022 in 2018 requiring third trimester testing for syphilis as well as HIV and hepatitis B. In 2009, Nevada updated their syphilis screening statues through SB 307 to include both the first and third trimester.

Improvement in syphilis screening for pregnant women can protect babies from this debilitating and sometimes deadly disease. To see your state’s current screening laws, the CDC has provided a list of state statutes related to screening during pregnancy for syphilis. For information on congenital syphilis in your area, CDC has specific numbers in their 2018 STD Surveillance Report.

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Charlie Severance-Medaris is a policy specialist in NCSL's Health Program.

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This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $120,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, or the U.S. government.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.