April is National STD Awareness Month and sexual and reproductive health organizations throughout the country urge you to Get Yourself Tested!! RH Reality Check has partnered with The National Coalition of STD Directors (NCSD) to produce a series of articles on the importance of STD prevention and treatment among populations throughout the United States. Other articles in this series include one by Sandra Serna-Smith, Dana Cropper Williams and Peter Leone and a feature article by William Smith published earlier this week.
Last week, and as part of STD Awareness month (April), I and several other colleagues wrote about just how significant the STD situation is in our country. It might not be in the headlines everyday, but we’ve got very serious STD epidemics affecting the most vulnerable in our society. This week, I want to pick up on a theme from my own article and that of my colleague Peter Leone in North Carolina: The issue of the resurgent syphilis epidemic in the United States.
Headlines were made recently about the shockingly high rates of syphilis among men who have sex with men. These rates are indicative of behaviors—such as not using condoms–that put people at risk for other sexually transmitted diseases, including HIV. But that is just one aspect of the resurgent syphilis epidemic. Another is the equally disturbing trends of syphilis infection passed along to babies by their mothers, known as congenital syphilis.
On April 16th, the CDC released new data about the rates of congenital syphilis (CS) and the trends are going totally in the wrong direction. From 2003 to 2005, there were roughly 339 cases per year in the United States. In 2008, however, nearly 100 additional cases of CS were reported for a total of 431 that year. That means nearly 500 children being born in 2008 with a totally preventable life-threatening illness.
CS is preventable. Treating maternal infection 30 days prior to delivery is highly successful in reducing or eliminating transmission. The CDC reports, however that in about a quarter of CS cases where maternal infection was detected within this 30-day window for treatment, an identified infection was left untreated. In another quarter of cases, infection was identified less than 30 days out from delivery and in about 30 percent of cases, no prenatal care was provided and infection was identified at the time of delivery.
What is worse: This isn’t just about babies born sick and easily treated with an “all’s well” ending. In 2007 and 2008, 54 babies born with CS were stillborn and another 7 died within thirty days of birth.
Drill down into the data a bit deeper and we find the same persistent and disturbing trends in terms of how this infection and its outcomes disproportionally affect the southern part of the country. Nearly 60 percent of all cases of CS in 2008 are in the South.
And of course behind the numbers of CS cases are also women whose sexual health is already compromised, particularly black women. Nearly 50 percent of all cases of CS were among those born to black mothers. An even more astonishing statistic provided by the CDC analysis that brings these two pieces of data to appalling convergence – 79 percent of those black mothers involved in CS transmission were from the South.
The current National Plan to Eliminate Syphilis sets a goal of reducing the rate of congenital syphilis to fewer than 3.9 per 100,000 births by 2010. It is highly unlikely that we will meet it. In 2008, the rate was 10.1 per 100,000 births. That is a huge gap to close when the evidence is all around that ground is being lost – not gained.
So, we have yet another window into a disturbing increase of syphilis in this country and it is part of a clarion call to renew and refresh our domestic commitment. This renewed effort must focus on greater efficacy of delivering treatment to pregnant mothers and the CDC recommends this going forward. The great success in preventing mother-to-child transmission of HIV is a good model to look to and the impact of health care reform may also hold promise. After all, good access to prenatal care could facilitate a dramatic drop in rates of syphilis and of CS. But we must focus these efforts and resources in the south where the ugly intersection of history and poverty allow syphilis to thrive.
A decade ago, we were on the precipice of a major public health success story in eliminating syphilis. In fact, syphilis rates in 2000 were the lowest since 1941 when it first became a reportable disease. Now, with insufficient resources and too much politics that has set back behavioral interventions and access to sexual and reproductive healthcare services, we have a big mess on our hands.
But it is a mess we can fix. And fix it we must.