Congenital syphilis cases on the rise in North Carolina and nationwide

Both nationally and locally, the number of reported congenital syphilis cases has seen its largest increase in decades, sexual health experts say. 

From 2019 to 2022, the number of reported congenital syphilis cases more than doubled in North Carolina, jumping from 27 cases in 2019 to 57 cases in 2022, according to the Mecklenburg County Health Department. 

Congenital syphilis occurs when pregnant women have untreated syphilis during their pregnancy, which can then be transferred to their unborn fetus. 

This can lead to stillbirths, miscarriages and neonatal deaths, according to Dr. Vicki Mobley, HIV/STD Medical Director at the North Carolina Division of Health and Human Services’ Division of Public Health. 

“Any congenital syphilis infection — just one — is a failure of our public health and our healthcare system,” Dr. Mobley said. 

Symptoms and outcomes

Possible long-term health outcomes in babies born with syphilis include deafness and blindness.

In adults, syphilis is acquired by direct contact with a syphilis sore during vaginal, anal, or oral sex. 

The infection develops in stages and has varying symptoms based on the stage. 

Some symptoms in adults include sores around the genitals, rectum and lips or in the mouth, according to the CDC.

Other symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches and weight loss, according to the CDC.

Historical rates

Historically, syphilis infections in the United States saw its largest spike during the mid-to-late 1940s, around WW2.  

Over 575,000 cases, of all stages, were reported in the United States in 1943, according to the National Library of Medicine

By 2000 and 2001, that number dropped to just over ​​6,103 cases reported — the lowest rates since the 1940s, according to the National Library of Medicine

However, data from the CDC has shown a sharp increase in cases of early syphilis diagnoses in adults since 2014.

Early syphilis cases increased from 420 in 2018 to 844 cases in 2022, according to a 2022 Mecklenburg County syphilis fact sheet. 

Approximately two in three of those new infections in 2022 were among non-Hispanic Black people and nearly 42% of those cases were among ages 25-34. 

Rates of congenital syphilis 

While Mecklenburg County’s reported cases are lower than the state’s, congenital syphilis is still rising throughout the county. 

In 2012, there was only one case of congenital syphilis reported among Mecklenburg County residents, according to the Mecklenburg County Health Department. 

That number has slowly increased to 12 cases in 2022, according to the Mecklenburg County Health Department. 

This increase in local congenital syphilis cases follows nationwide trends.

The number of reported congenital syphilis cases in the United States increased by 939%, from 362 cases in 2013 to 3,761 cases in 2022, according to the Mecklenburg County Public Health Department. 

‘Completely preventable’

“It’s really a tragic infection to not identify and treat, particularly because it’s completely preventable,” Dr. Mobley said. “We have medicine to treat it.”

Dr. Mobley described the increase in cases as “concerning.” 

The causes for the increase are multifaceted, Dr. Mobley said. 

She says the increase is likely indicative of an increase in unrecognized or undiagnosed cases of syphilis in reproductive-aged women (ages 14 to 45). 

“Whenever you see an increase in syphilis in females, particularly in women of reproductive age, unfortunately, we see an increase in congenital syphilis infections, and that’s what’s happening nationally and in North Carolina,” Dr. Mobley said. 

Syphilis is one of the only STIs that increased during the pandemic in North Carolina, Dr. Mobley said. 

Dr. Mobley said this could be due to a lack of access to testing and treatment available during the pandemic. 

Protecting one’s health

Dr. Mobley says every community should be concerned about syphilis and should be taking steps to mitigate the increasing trend of syphilis cases. 

“We’ve seen an increase in congenital syphilis across all races and ethnicities,” Dr. Mobley said. “It’s not just any one demographic group’s burden.”

Prevention and early diagnosis are important steps to preventing and treating syphilis, Dr. Mobley said.  

“It is a treatable, curable infection,” Dr. Mobley said. “The key is prevention, but if not prevention, then early diagnosis and treatment to prevent further transmission.” 

Dr. Mobley encourages anyone sexually active to “prioritize their sexual health” by scheduling routine STI tests.

“Get yourself tested,” Dr. Mobley said. “The more testing, the better. It’s just a matter of not feeling ashamed and feeling empowered to get the healthcare you deserve.”

Dr. Mobley also recommends talking to your sexual partners about sexual history and getting tested every time you have a new sexual partner.

“Anytime you have a new sexual partner, it’s good practice for you both to go and get tested together before you start having sex, so you both know your status and can prioritize any treatments that need to happen,” Dr. Mobley said.  

For free, on-site screening and treatment for sexually transmitted infections, make an appointment with the Mecklenburg County Health Department at 704-336-6500.

For a full list of STI testing locations in the area, visit the Mecklenburg County Health Department’s website

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