Editor’s note: For more coverage of the 2024 AAP National Conference & Exhibition, visit https://bit.ly/AAPNationalConference2024 and follow @AAPNews on LinkedIn, Facebook and X.
A neonatologist at the 2024 AAP National Conference & Exhibition called on pediatricians to watch for cases of congenital syphilis and know how to manage them as cases surge.
“Syphilis has come back to the United States with a vengeance,” said W. Christopher Golden, M.D., FAAP, associate professor of pediatrics at the Johns Hopkins University School of Medicine and medical director of the newborn nursery at Johns Hopkins Hospital.
There were 3,766 cases of congenital syphilis in 2022, up from 300 in 2013, Dr. Golden said citing Centers for Disease Control and Prevention (CDC) data.
Congenital syphilis disproportionately impacts some racial and ethnic groups. Black infants represented about 14% of live births in 2022 but nearly 30% of congenital syphilis cases that year, said Dr. Golden, a member of the AAP Section on Neonatal-Perinatal Medicine. That year, Native Hawaiian/Pacific Islander infants and American Indian/Alaska Native infants had case rates of one in 247 live births and one in 155 live births, respectively. On the other end of the spectrum, Asian and white infants had case rates of one in 9,588 and one in 1,848, respectively.
Across all races, there were 231 stillbirths and 51 infant deaths related to syphilis in 2022, up 904% and almost 1,200%, respectively, from 2013.
“These are deaths and stillbirths that could have been avoided,” Dr. Golden said.
Screening and treatment are key to preventing these losses. However, testing mandates for people who are pregnant vary by state.
Arizona, Alabama, Georgia, Mississippi, North Carolina and Texas mandate screening at three points in pregnancy and Maryland soon will join them. Hawaii, Iowa, Minnesota, New Hampshire, North Dakota and Wisconsin don’t mandate any testing.
Dr. Golden called the disparity “very disturbing” and quoted the AAP Red Book, which says, “No newborn infant should be discharged from the hospital without confirmation of the birthing parent’s serologic status for syphilis.”
“This is drilled into my residents’ heads repetitively, and it should be a dictum that we keep on our minds with every newborn delivery,” he said.
Because parental testing is not universal, he urged clinicians to keep syphilis as part of the differential diagnosis of infants and children with relevant clinical findings and to keep in mind some children don’t have signs and symptoms until after 2 years of age, which is known as late congenital syphilis.
Diagnosis of congenital syphilis can be difficult as about 60% of newborns are asymptomatic and clinical findings can be non-specific like jaundice and fever. Clinical findings of late congenital syphilis tend to be more clinically significant, according to Dr. Golden, and may include corneal clouding, keratitis and bone and dental malformations.
The AAP Red Book has detailed information on signs and symptoms and a diagnosis algorithm.
The go-to treatment for syphilis is penicillin G. However, some forms of benzathine penicillin G remain in shortage. The Food and Drug Administration has allowed importation of antibiotics from other countries to help fill the gap.
Resources
