Jami Lewis, MD, FAAP
Providence Sacred Heart Children’s Hospital
Washington, especially Spokane County where I practice neonatology, is experiencing a devastating rise in the incidence of syphilis cases in women. Not surprisingly, congenital syphilis cases have also been rising. Cases seem to be related to increasing illicit drug use in women of childbearing age. The standard practice of screening for syphilis once early in pregnancy is failing to identify later maternal infections and opportunities to effectively treat the disease. A new approach to prevention and treatment of syphilis needs to be considered. The Spokane County Regional Health District (SRHD) in conjunction with the Centers for Disease Control is now recommending that:
1) All women be tested early in pregnancy,
2) All women be re-tested in the third trimester, and
3) All women be re-tested at time of delivery.
This re-testing should be particularly considered if women meet any of these criteria:
- Any STD diagnosis in pregnancy, even if detected only at their initial prenatal visit,
- New or multiple sex partners in pregnancy,
- Substance use (current or historic), particularly methamphetamine, in woman or her partner,
- Extended gaps in prenatal care.
Women infected with syphilis should be treated immediately. Benzathine penicillin, or Bicillin L-A, is the only treatment for syphilis in pregnancy that is considered reliable to cure the fetus; if allergic, patients must be desensitized. Spokane Regional Health District (SRHD) will deliver Bicillin to physician offices directly upon request. Women not treated immediately are often lost to follow-up.
Pediatricians can be aware of these risk factors in maternal history when we see newborns and confirm at the time of delivery that maternal syphilis testing was completed and make recommendations for re-testing mothers as necessary. Results will allow for effective treatment of newborns and avoid them experiencing the more serious effects of syphilis.
We are obligated to report all cases of syphilis in pregnant women or infants to the local health department. Kirsten Duncan, MPH, the lead intervention specialist of the Spokane Regional Health District HIV/STD prevention program, follows all cases of maternal and newborn syphilis in Spokane County. She provides physicians with the most current testing and treatment recommendations, educates state and local groups, and also works directly with patients providing screening opportunities and medication. She can be reached at the SRHD 509.324.1635 or firstname.lastname@example.org.
You can also bookmark this DOH page as a resource, and contact Zandt Bryan, HIV/STD Public Health Program Advisor for Washington State Department of Health, at 360-890-5816.
“In general, it’s a good idea for providers to contact their local health department,” says Kirsten Duncan. “Each county is assigned at least one DOH Infectious Disease Field Services Consultant who typically advise on more complex cases such as congenital syphilis, and communicable disease staff at each health department should be able to link a provider with the local field services consultant if they cannot address the questions themselves.”