Syphilis infections are rising in Northeast Ohio. That poses risks for unborn babies

The increase in the number of syphilis infections across Northeast Ohio has doctors worried, and some report they are screening more women and girls for the disease, which can be particularly devastating for babies exposed in the womb.

Nationwide, the number of people across the country who have contracted syphilis, a bacterial sexually transmitted infection (STI) that appears as genital sores but can cause severe symptoms and even death if untreated, has grown since 2017, according to the Centers for Disease Control and Prevention (CDC). Last year, infections increased by 30% with the most significant increases reported in women.

That spike in cases is also leading to an increase in the number of cases of congenital syphilis, when an unborn baby is exposed to the disease in the womb. Cases last year grew by 24%.

Cases increase locally

In Cuyahoga and Summit counties, syphilis rates increased by 60% and 55% respectively in recent years, according to figures from county boards of health.

Several years ago, it would be rare to have a single congenital syphilis in Summit County. But this year, public health officials have reported five suspected cases so far.

“We are unfortunately well aware of the increasing cases of syphilis as well as congenital syphilis in the county and state and are actively targeting practices with current updated testing guidance as it is published,” said Marlene Martin, the community liaison for Summit County Public Health (SCPH).

In September, the U.S. Preventive Service Task Force, a group of medical professionals who make recommendations on best practices to prevent disease, reissued recommendations that doctors screen all adolescent girls and women who are at risk for syphilis, regardless of whether or not they are pregnant. Risk is determined by doctors who consider the patient’s sexual activity and the prevalence of the infection in the community.

Pregnant women are routinely tested for syphilis because an untreated infection in newborns can lead to neurological problems or even death. In Ohio, the law requires that pregnant people be screened at their first prenatal visit, according to the CDC. But because rates are so high in Northeast Ohio, some doctors are now screening all women.

Dr. Heidi Gullett, an associate professor at the Center for Community Health Integration at the School of Medicine at Case Western Reserve University, said she’s always erred on the side of screening more and has noticed more patients testing positive recently.

“I feel as a clinician that I should be offering this to everyone who is sexually active, including adolescents, including older individuals,” she said. “I shouldn't make the determination about someone's sexual practices. I should ask, and I should offer it.”

Screening saves lives

Because syphilis can be hard to identify, Gullett said doctors in the community should be screening women for the infection at every doctor’s visit, regardless of whether they’re there for prenatal care or a possible STI infection.

The infection can be cleared up quickly with antibiotics. However, babies born to women who have untreated syphilis while pregnant have a 40% chance of being stillborn or dying shortly after birth, according to the CDC. Those that survive may end up with deafness, blindness and intellectual and cognitive impairment.

Adarsh Krishen, the chief medical officer at Planned Parenthood of Greater Ohio, said most OBGYN providers pay attention to the screening guidelines, but some women slip through the cracks — either because they delay getting care or because they don’t disclose information.

“You don't just go to your health care provider to listen for heart tones and say, 'Hey, take your prenatal vitamins.’ There are other important things that the screenings and testing that need to be done early in pregnancy and all along throughout the pregnancy,” he said.

Doctors’ biases may also play into whether they screen someone for syphilis, Krishen said. Men who have sex with men are at greatest risk for contracting the STI, but sometimes those men have partners with uteruses too.

“As we live in a world where relationships are more fluid, I think that that there is more risk there,” he said. “[Doctors and patients] don't always think about and consider the risk there.”

Planned Parenthood hasn’t increased screenings because they are already included in most appointments, Krishen said. But it has documented an increase in testing because of patients disclosing information.

“It’s easier to catch it by screening questions because the classic presentation of syphilis is a painless lesion in the genital area,” he said. “It only lasts for a certain period of time and then it goes away. Your syphilis infection has not gone away, but you would have no symptoms to suggest that you have an infection.”

If people don’t get screened or notice symptoms, Krishen said there’s potential to transmit the virus or delay the care they need until much later.

“Early detection is the key to helping resolve or prevent the long-term problems and complications,” he said. “The more awareness people have, the earlier they're screened, tested and then get treated, the much better outcomes that are for everybody.”

Need for more screening

As for why the country is seeing an uptick in infections, Krishen of Planned Parenthood has theories. In recent years, with medication that can prevent and treat HIV, he’s noticed some people have been less concerned with safe sex practices.

“They’ve become a little bit more lax in their usage of [condoms] because the they don't necessarily see or perceive the risk of other STIs as being such a significant concern to them,” he said.

Online dating has also made it easier to find anonymous partners and engage in riskier sexual behavior, Krishen said. Meanwhile, the state has cut funding for Planned Parenthood STI clinics, which he said were a convenient place for some people to get tested.

“Syphilis has been a relatively quiet disease,” Krishen said. “I think there probably has been less energies and efforts towards screening than previously.”

He says the evidence-based updated recommendations help remind doctors. Electronic patient records also prompt screenings, which is another way doctors can make sure to fit them in during exams.