Citing a statewide “crisis” in the growing number of babies born with syphilis, state health officials are urging providers to increase screening and treatment to curb the alarming trend.
Congenital syphilis is transmitted to fetuses by parents with the infection. In a Feb. 25 letter to Oregon providers, Dr. Pete Singson of the Oregon Health Authority wrote that just two babies were born with it in 2014, but the number climbed to 30 in 2023 and jumped to 45 last year.
The growth in cases is happening primarily in rural Oregon.
The condition is entirely preventable, but “the consequences of untreated syphilis during pregnancy include miscarriage, growth restriction, preterm birth and fetal demise,” he wrote. “In the newborn, nearly every organ system can be affected.”
Severe cases can lead to the infant dying shortly after being born, he added.
Singson, who serves as medical director for the state public health program working on HIV, sexually transmitted infections and tuberculosis, told The Lund Report that he wants to raise awareness and prompt a more aggressive statewide approach, including timely and more widespread screening.
“We need to explore more innovative ways to get treatment out to the people who need it,” he said.
Syphilis among adults can be difficult to detect without testing, especially for a generation of U.S. medical professionals accustomed to low syphilis rates during the 1990s and 2000s, according to Singson. Painless syphilitic lesions can easily be written off as an ingrown hair.
Awareness is not the only challenge. Another is access.
According to the agency, two-thirds of the cases stem from patients receiving no prenatal care. Another 20% of patients don’t receive prenatal care until the third trimester, according to Oregon’s 2023 data.
Normally the agency recommends screening at the initial prenatal visit, at the beginning of the third trimester and at delivery.
Children born with syphilis may not have signs or symptoms of disease, according to the National Coalition of STD Directors, but babies may develop serious problems within weeks if not treated immediately with penicillin. Left untreated, newborns can develop bone deformities, become blind or deaf, or experience issues such as seizures or developmental delays.
Syphilis leveling off, except among babies
Syphilis cases of all types had been growing across the country, including in Oregon, before starting to decline in 2023.
According to the agency, the growth in babies infected in Oregon reflects in part a lack of medical care or access to care — simply put, poverty.
Previously, congenital syphilis tended to occur in cities. But increasingly in Oregon, it’s showing up in rural areas. In fact, nearly half of last year’s cases were reported outside of the Portland metro area.
According to the agency, just over half of the congenital syphilis cases in 2024 involved parents who'd used drugs during the 12 months prior to delivery. And about half of the cases 2023 were affiliated with parents who had unstable housing.
“Definitely we're seeing a strong association with housing instability — obviously poverty and substance use disorder — linked to general syphilis cases,” Singson said. “As you might imagine, someone who's unstably housed or dealing with addiction, you know, getting registered into prenatal care or being able to attend a prenatal care visit is going to be a challenge, for sure. It may not be high on their priority as far as things to do in the day, as opposed to getting food or shelter.”
Not only that, but also 60% of the pregnancies associated with congenital syphilis in 2023 involved people diagnosed with gonorrhea and/or chlamydia in the previous two years.
Congenital syphilis rates over the past few years were disproportionately higher among Black and Native populations in Oregon, according to the agency. Dr. Singson said the history of racism against minority groups in the medical field, such as the Tuskegee Syphilis Study directly targeting Black patients for unethical syphilis experimentation from 1932-1972, may deter people from seeking medical care.
Measures to increase screening can be controversial among providers. Hospitals and emergency room physicians are opposing a bill, HB 2943, supported by Basic Rights Oregon and Cascade AIDS Alliance, to require HIV and syphilis testing for anyone admitted to hospital emergency departments. Opponents say that screening is better done at outpatient providers, not hospitals.
Agency seeks coordinated strategy
Dr. Singson said that the OHA is working with local public health authorities and community-based organizations on ways to expand testing and improve access, or at least linking people to prenatal care services.
State and county officials are working together, he said, to determine where providers have needs for testing kits, for example. The agency is working with counties to improve contact-tracing when syphilis is detected.
Providers, Singson added, should encourage consistent condom use among their patients and educate people about doxycycline, an antibiotic that can be used post-exposure to reduce the risk of syphilis and chlamydia.
“If a pregnant patient shows up to an emergency department, an urgent care center, an addiction treatment program, corrections facilities, please screen for syphilis,” he said. “By identifying pregnant patients with syphilis in these settings, we can hopefully close the gap on these missed opportunities for treatment.”
