A group of about 50 University Hospitals emergency medicine doctors wait quietly before a presentation begins at their main campus in Cleveland. Residents meet here for trainings often, but they don't usually talk about today's subject: congenital syphilis, a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy.
“Congenital syphilis has been kind of brewing as a buzzword here for a few months," said Alisha Cassady, an epidemiologist for the Cuyahoga County Board of Health. "The situation is dire."
Rates are skyrocketing locally. In region 3, covering Ashtabula, Cuyahoga, Geauga, Lake, Lorain and Medina counties, congenital syphilis rose from one case to 18 last year. Cassady said that's a historic high for the area. It's mirroring trends across the state and country. The Centers for Disease Control and Prevention found the rate of maternal syphilis increased 222% from 2016 to 2022.
Cassady told the ER doctors the highest number of these cases are found among young moms, ages 20 to 24. Most of them did receive some prenatal care, she said. Doctors are required to screen for syphilis at the first prenatal appointment.
“Over half of [pregnant women in the region who had syphilis] were not tested at that 28 to 32 week mark," Cassady said. "This is essential because at the 28 to 32 week mark is usually about the last chance where treatment can happen, and it can prevent syphilis from being passed on to the baby.”
Women who are pregnant and aren’t treated for syphilis, or who are treated too late during pregnancy, can miscarry, deliver a stillborn or the baby could die shortly after birth. The child can have deformed bones, severe anemia or neurological defects such as hearing and sight loss.
This was the second presentation Cassady did in a few months, meeting with Cleveland Clinic ER doctors in December last year. She's pushing the physicians to order syphilis tests for any pregnant person who appears at the ER because it may be the only place they are going for care.
“You don't know what kind of care follow-up they're receiving," Cassady said. "We don't know if they've even had any prenatal appointments or maybe they just have the one and aren't following up."
A doctor in the audience, Dr. Dylan Sexton, asked a question about a dilemma he’s faced in the ER.
“For the pregnant patients, if they’ve told me they had HIV and syphilis tested during this pregnancy, I will put it down to their discretion," he said. "Usually they decline because they've already had the test done. Are you recommending that we do any pregnant patient coming in, even if they've had a test previously?”
Cassady responded with an unequivocal, "Yes."
According to regional data, 71% of women who later delivered a syphilitic baby were tested at an initial prenatal appointment, she said.
“Usually if they're going and they went to that first prenatal appointment, a lot of times around like eight to 10, sometimes 12, weeks, and then they're not tested again, maybe until like 28, 32 weeks," she said. "So there's a big window of time there that syphilis can happen."
But increasing testing can’t be the only remedy, Cassady noted.
She said almost half of women who passed syphilis to their babies received a positive diagnosis before the birth. That indicates the mothers aren’t getting adequate treatment or prenatal follow-up, she explained.
Melissa Kolenz and her team of 11 disease intervention specialists try to be that stopgap.
They investigate each syphilis case in region 3 and follow up by calling patients who test positive to make sure they are informed of the diagnosis and get connected to care.
Right now, more syphilis cases in the community means one specialist may be juggling up to 15 cases at a time, Kolenz said.
Those cases can take a while to close.
“Sometimes we'll meet them at their appointments and work with their providers that way to make sure that everybody's on the same page and they understand what's going on," she said.
Still, some don’t follow through on their treatment plan. For pregnant people, the only safe treatment is injections of penicillin G benzathine, also called Bicillin, given over three consecutive weeks.
“Not everybody is ready to hear that diagnosis," Kolenz said. "Not everybody is a big fan of shots or taking meds. It's also remembering to take meds as needed.”
Other organizations and providers are jumping on board to try and identify more syphilis in the community. Neighborhood health clinics are offering more STD testing and raising awareness through billboards and emails.
Those organizations said the key is building up trust between patient and provider, so patients feel they can be open about something that’s still stigmatized for many.
People can get tested for sexually transmitted infections at their local health provider and many pharmacies, at the Cleveland Department of Public Health clinic locations, or at the AIDS Healthcare Foundation wellness center located at 2829 Euclid Ave. in Cleveland.
![This 1972 microscope image provided by the Centers for Disease Control and Prevention shows a Treponema pallidum bacterium which causes the disease syphilis. [Susan Lindsley/CDC via AP]](https://npr.brightspotcdn.com/dims4/default/554449b/2147483647/strip/true/crop/3059x1704+0+153/resize/560x312!/format/webp/quality/90/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fab%2F20%2F1ab87bcc40ecade94e1c0b251c42%2Fap18268570695909.jpg)
