The prevalence of syphilis in individuals of childbearing age has significantly risen, leading to an increase in cases of congenital syphilis (CS). Co-infection of syphilis and HIV among pregnant patients also poses a higher risk of vertical transmission of HIV. However, all instances of CS and vertical HIV transmission can be prevented through increased testing and appropriate treatment. Vertical transmission refers to the transfer of viruses from mother to baby during pregnancy.
In Missouri, there has been a notable surge in CS cases, with 63 reported cases in 2021, the highest number since 1994. CS can result in miscarriage, stillbirth, infant death, and long-term disabilities, making it crucial to conduct timely syphilis testing and treatment for pregnant women. In St. Louis County and the City of St. Louis, there were 56 cases of CS reported from 2020 to 2022, surpassing the total number of cases reported in the past 20 years (47 cases from 1999 to 2019).
Along with the rise in CS cases, there has also been an increase in perinatal HIV transmission in Missouri, as well as a higher incidence of pregnant individuals co-infected with syphilis and HIV. For pregnant patients who are HIV positive, the risk of vertical transmission is significantly higher when they also have syphilis. However, with appropriate testing and treatment, all cases of vertical HIV transmission can be prevented. Studies have shown that mothers co-infected with HIV and syphilis have twice the odds of transmitting HIV to their babies, and a significant number of infants acquire HIV in utero.
To address this issue, it is recommended that healthcare providers routinely test pregnant patients for syphilis three times during pregnancy – at the first prenatal visit, at 28 weeks, and at delivery. Routine testing for HIV is also crucial for pregnant patients. Additionally, individuals living with HIV should be regularly tested for syphilis, especially pregnant patients, due to the increased risk of perinatal HIV transmission from co-infection. It is essential to implement these recommendations to prevent cases of CS and vertical HIV transmission and ensure the health and well-being of both mothers and babies.