Amid an increase in adult and congenital infections, the Suffolk County Department of Health Services is urging pregnant mothers to get tested for syphilis.
Untested and untreated, infants born with the congenital bacteria can appear normal and healthy but can encounter developmental delays and health challenges later in their lives.
The county recommends that pregnant women get tested for syphilis at their first prenatal visit, at the beginning of their third trimester and again at delivery.
“Syphilis during pregnancy is easily cured with the right antibiotics,” Mary Pat Boyle, bureau chief for the Suffolk County STI Control Unit and member of the New York State Congenital Syphilis Elimination Strategic Planning Group, said in an email.
Pregnant New Yorkers can qualify for Medicaid at higher income levels. Uninsured pregnant residents may quality for a Special Enrollment Period to enroll in private health insurance through the NY State of Health Marketplace.
The county recognizes that “barriers to testing and treatment do exist,” Boyle said. “The county staff is aware that patients turning to urgent care for support find that the centers don’t treat syphilis and are referred to another provider causing delays in their treatment.”
At the same time, staff at Suffolk County, which has been social messaging about STIs during STI Awareness Week, has confronted issues with insurance companies that don’t cover benzathine penicillin G 2.4 million units, the medication needed in one to three doses as recommended by the Centers for Disease Control and Prevention and the only treatment safe for pregnant women.
Suffolk County Department of Health Services brought this to the attention of NYSDOH, which is “looking into the matter,” according to county officials.
The incidence of syphilis for the population of the country has climbed dramatically. A report from the CDC showed that the number of cases of syphilis rose 32% to over 176,000 in 2021 from the prior year.
In New York State, pregnant persons with reported syphilis increased by 51% in 2020 to 53 from 35 in 2016.
In July 2022, Suffolk County’s Board of Sexually Transmitted Disease staff launched the Suffolk County Congenital Syphilis Prevention Initiative.
“The groups have been raising awareness of increased cases of maternal and congenital syphilis among those who work with at-risk women of childbearing age and mobilizing to implement evidence-based practices to prevent congenital syphilis,” Boyle said.
The bureau staff has visited over 167 Suffolk County OB/GYN providers to discuss best practices and distribute educational materials emphasizing the importance of STI testing and timely treatment.
The county’s STI unit is planning training for team members at St. Catherine of Siena Hospital, Southampton Hospital, Stony Brook University Hospital and Planned Parenthood Hudson Peconic.
Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, noted the increase in congenital syphilis and suggested that newborns don’t necessarily show clear signs of the infection.
“You sometimes don’t know until perhaps years later, when the baby is not growing, thriving and meeting developmental milestones” that it has syphilis, Nachman said. “There are no abnormal blood tests. The baby looks fine.”
Nachman said that parents and doctors don’t want to “be in a position where you’re picking it up late” because untreated and untested syphilis could have a “lifelong” effect on the growing child.
Nachman added that testing for syphilis in newborns often involves a spinal tap, in which doctors take a small amount of fluid through a spinal tap. Spinal tap procedures in newborns can involve pain and tenderness, but do not generally present risks to the developing child.
Penicillin shortage
At the same time, the supply of penicillin could become a concern. As a generic drug, the profitability of penicillin has decreased dramatically.
The injectable form of penicillin, which is used to treat syphilis, may become a problem later this year and will “definitely be a problem next year and afterwards,” Nachman said.
Researchers are checking to see if there are other drugs, they can fine tune instead of penicillin. They are exploring whether they can convert other therapies that are short acting into longer acting treatments.
“Everyone is aware of the question and [researchers] are carving out different ways to answer” it, Nachman said.
If the county uncovers a shortage of syphilis treatment, it will work with the New York State Department of Health to address the problem, county health department officials said.
For adults, Nachman suggested that seeing an increase in syphilis among newborns suggest that the bacteria may be prevalent in the community.
“When I see an uptick in neonates, I think, ‘Oh, gosh, there are more adults out there’” with this infection, she said.
