Those trends have combined to affect “women from vulnerable communities … usually women who are Black or brown, with lower financial means, lack of access to transportation, [and] inability to take time off work,” says Natasha Bagdasarian, a physician and the chief medical executive for the state of Michigan, which had 38 congenital cases of the disease in 2022. “What we’re seeing when we review cases of congenital syphilis are individuals who, rather than have a single healthcare provider through their pregnancy, have gone to urgent cares or ERs, or gone to one physician and then switched to another because of life circumstances.”
A study presented on Sunday, November 12, at the American Public Health Association’s annual meeting in Atlanta demonstrated who the most vulnerable women are, using one state’s hospital discharge data, which contains diagnosis codes for insurance billing. In Mississippi, 367 infants were born with congenital syphilis between 2016 and 2022, according to Manuela Staneva, an epidemiologist with the Mississippi State Department of Health; there were 10 cases in 2016 and 110 in 2022, a 1,000 percent increase. Among the mothers, 93 percent were on Medicaid, indicating they were poor; 58 percent lived in rural areas; and 71 percent were Black—a signal of the unequal influence of race on health, because the state population is only about 38 percent African American. (This data was also published recently in Emerging Infectious Diseases.)
“This is the price paid by babies,” Staneva said in her presentation. “It’s pretty disturbing.”
At this point, most states require women who make it to doctors’ offices during their pregnancies to be tested for syphilis at least once. Some jurisdictions, including New York, require a third-trimester test in addition to a first-trimester one. Mississippi instituted first and third trimester screening last March, just a few months after its health department, including Staneva, began investigating congenital syphilis there. Still, a handful of states have no such laws.
Yet mandating testing hasn’t solved the nationwide problem because the process of syphilis testing doesn’t match the reality of the lives of marginalized women. The gold standard for detection is to perform a blood test, send it off to a lab, receive the results several days later, and then bring the woman back to her healthcare provider for the shot. That is more follow-up than some women can navigate. “There are times when we test somebody and it can take more than a week for the results to come back,” says McDonald, who sees patients in Atlanta. “It’s really hard to track people down again: They’ve forgotten about their concerns, other things have come up in their lives, sometimes their phones get disconnected.”