US state sees 1,000% spike in congenital syphilis in just 6 years
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Key takeaways:
- Mississippi’s 10-fold spike in cases of congenital syphilis is the largest in the U.S., which has seen cases triple in recent years.
- Mississippi has the highest preterm birth and infant mortality rates in the country.
Infant hospitalization for congenital syphilis increased 10-fold from 2016 to 2022 in Mississippi, from 10 cases per year to 110 cases per year, according to an analysis of hospital discharge data.
Congenital syphilis cases in the U.S. have more than tripled in recent years, according to the CDC. The more than 2,000 cases reported in 2021 was the highest total since 1994.
Multiple factors have been linked to recent increases in congenital syphilis, including access to care, psychiatric conditions and substance abuse.
Mississippi has the highest preterm birth rate (14.96%) and highest infant mortality rate (9.39 per 1,000 live births) in the U.S., according to the CDC, and the increase in congenital syphilis there is making it worse, Manuela Staneva, MD, MPH, an epidemiologist in the Mississippi State Department of Health, and colleagues wrote in Emerging Infectious Diseases.
“Although the upward trend was consistent with national-level surveillance data for [congenital syphilis], the upturn in Mississippi was even steeper,” Staneva and colleagues wrote. “This spike is troubling because decades of research have demonstrated the dire health consequences of [congenital syphilis], including prematurity, low birth weight and death.”
Staneva and colleagues performed a retrospective cross-sectional analysis of hospital discharge data collected by the Mississippi State Department of Health and the Mississippi Hospital Association from 2016 to 2022, identifying 367 infants who were hospitalized and diagnosed with congenital syphilis, roughly half of whom were male.
Of the 367 infants, 97.6% were newborn (aged 28 days or younger), 92.6% were covered by Medicaid, 71.1% were African-American and 58% were residents of nonurban counties.
According to the analysis, the rate of infant congenital syphilis hospitalization in Mississippi increased from two per 10,000 total infant hospitalizations in 2016 to 24.8 per 10,000 total infant hospitalizations in 2022 — a 1,140% increase over the study period.
Between 2019 and 2022, six infants with congenital syphilis in Mississippi died in the hospital, half of whom died in 2022. Among the six infants, 83.3% had extremely low birth weight and 66.7% were extremely premature.
According to the researchers, the six infant deaths provide evidence that the spike in congenital syphilis cases in Mississippi is contributing to the state’s already high preterm birth and infant mortality rates.
“Half of those deaths occurred in 2022, underlying the current nature of this rapidly escalating reemergent public health menace and urgent need for public health interventions,” Staneva and colleagues wrote. “Infant deaths associated with [congenital syphilis] are preventable. Mississippi could reduce infant illness and death by promptly diagnosing and treating pregnant patients with syphilis.”
Nearly one in four infants with congenital syphilis during the study period was born to a mother with a substance use disorder, a finding that Staneva and colleagues wrote “reveals the entanglement between the ongoing drug epidemic and the resurgence of maternal and congenital syphilis, and suggests the need for holistic approaches that treat illicit drug use as one way to curtail” rates of congenital syphilis.
References:
- Staneva M, et al. Emerg Infect Dis. 2023;doi:10.3201/eid2910.230421.
- CDC. Sexually transmitted diseases: Congenital syphilis— CDC fact sheet. https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm. Updated April 11, 2023. Accessed Sept. 27, 2023.
- CDC. National Center for Health Statistics: Infant mortality rates by state. https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm. Updated Sept. 12, 2023. Accessed Sept. 27, 2023.
- CDC. National Center for Health Statistics: Percentage of births born preterm by state. https://www.cdc.gov/nchs/pressroom/sosmap/preterm_births/preterm.htm. Updated Feb. 25, 2022. Accessed Sept. 27, 2023.
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