Will the COVID-19 pandemic affect the incidence of congenital syphilis?
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The COVID-19 pandemic has affected many aspects of life in the United States and impacted the transmission of numerous infectious diseases.
We asked Jennifer Mahn, MPA, associate director of clinical programs at the National Coalition of STD Directors (NCSD), if it will influence the incidence of congenital syphilis.
It already has and will continue to do so until all levels of the nation’s public health system coordinate to implement a national prevention and treatment plan.
For the sixth consecutive year, the CDC reported record-high rates of sexually transmitted infections in 2019, and we are anticipating the report for 2020 to show more bad numbers. The national surveillance system for STIs has been drastically disrupted because of the pandemic, but we have every reason to believe that STI rates will continue to rise in the U.S.
NCSD’s own research has shown a dramatic interruption to STI clinical and prevention services, meaning fewer people are getting tested and educated about STI prevention. The COVID-19 pandemic led to an inability to conduct field visits, significant sexual health clinic staff redeployment and even sexual health clinics being used as COVID-19 testing sites. In fact, 83% of STI programs reported deferring services or field visits because of the COVID-19 response.
According to a March 2021 article in The Lancet, researchers found maternal and fetal outcomes have worsened during the COVID-19 pandemic, with considerable disparity between high-resource and low-resource settings. The pandemic exacerbated existing challenges that pregnant mothers experience engaging with the health care system, including access to transportation and programs supporting prenatal care coordination.
Furthermore, the pandemic has reduced access to the gold standard of treatment of syphilis for pregnant mothers — injectable penicillin G benzathine. It is often found in sexual health clinics, which are some of the few nonhospital clinical service providers that offer this treatment. Pregnant women who are diagnosed with syphilis are frequently referred to these clinics for treatment by their primary care or OB/GYN providers who do not have it available at their clinics because it is expensive and difficult to store. When the pandemic forced these clinics to close, pregnant women who needed this treatment could not access it, leading to increased cases of babies born with syphilis.
Once the pandemic lessens, access to testing should increase, and the system may likely catch up. However, limited testing and decreased access to expert STI clinical services means more people will not be treated, further fueling an STI epidemic that is driven by health disparities, particularly among marginalized populations, anemic public health infrastructure and a lack of appropriate coordinated engagement with the health care system for pregnant mothers, including testing and treatment of STIs. For congenital syphilis, the rates will likely mirror the larger community increases, and unfortunately, I predict more babies — not fewer — being born with syphilis.
- References:
- Chmielewskia B, et al. Lancet Glob Health. 2020;doi:10.1016/S2214-109X(21)00079-6.
- National Coalition of STD Directors. COVID-19 and the state of the STD field, phase III. https://www.ncsddc.org/resource/covid-19-and-the-state-of-the-std-field-phase-iii/. Accessed May 26, 2021.
Click here to read the Cover Story, "US sees ‘shameful’ rise in congenital syphilis cases".
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