Last week, on the heels of the Centers for Disease Control and Prevention’s newest surveillance report on sexually transmitted infections, a little-known infection affecting newborns made news. Congenital syphilis, a condition where pregnant women pass syphilis to their babies during pregnancy or childbirth, is on the rise in the United States. During 2015, 487 cases of congenital syphilis were reported, an increase of six percent over 2014. A CNN article on the report called this “one of the most disturbing findings,” especially because congenital syphilis is entirely preventable.
While the United States is rightly alarmed at this recent increase to hundreds of congenital syphilis cases, women and babies in middle- and low-income countries suffer in significantly greater numbers. In India, for example, more than 100,000 pregnant women get syphilis each year—and in Nigeria and Zambia 75,000 and 9,000 pregnant women, respectively, contract the infection annually. About one-third of these women’s babies will be affected by syphilis, leading to miscarriage, premature birth, stillbirth, or a range of other birth defects.
A new report by PATH, Congenital Syphilis in Nigeria, Zambia, and India: Identifying Policy Pathways to Eliminate Mother-to-Child Transmission of Syphilis, examines the toll of congenital syphilis in these three countries, and government efforts to not only tackle—but eliminate—the infection among newborns. It offers specific policy recommendations for decision-makers to advance in each of those countries to help ensure that all mothers are tested and treated, so that no babies suffer from syphilis.
Challenges on the road to elimination
Treating syphilis with penicillin, which cures the mother and prevents infection of her baby, is simple and cost-effective. Photo: PATH/Evelyn Hockstein.
Syphilis affects hundreds of thousands of pregnant women and children each year, but the infection is relatively easy to detect and treat, and mother-to-child transmission is entirely preventable. Both traditional laboratory tests and rapid diagnostic tests, which provide results easily and quickly, are globally available. Once the infection is detected, treating syphilis with penicillin, which cures the mother and prevents infection of her baby, is simple and cost-effective.
Still, congenital syphilis remains a major health problem. Detecting syphilis in pregnant women early in their pregnancies is key to prevention and treatment, but health centers in most resource-constrained environments don’t provide routine testing during antenatal care. Traditional tests, which require laboratory equipment, technicians, and electricity, are often not available. And although rapid tests are easy to use in all health settings and can expand access for women at the lowest levels of care, they have not been adopted in all countries.
Policy challenges and lack of funding also impede efforts. At the government level, data tracking systems are often weak, while strategies don’t provide a mandate for health centers to prioritize testing. Where policies do exist, they are often not implemented. And because congenital syphilis has historically been lost in the shuffle of other, more visible health issues, funding streams are woefully inadequate to support testing and treatment.
In sight: a world where no baby is born with syphilis
But progress today is being made, the new report finds. The Indian government recently announced a commitment to eliminate congenital syphilis, under a national strategy to bring all partners together. A follow-up action to fund simple, rapid testing kits for all antenatal health centers means that an India free of mother-to-child transmission of syphilis may soon be on the horizon. In Zambia, the government has prioritized maternal syphilis screening and treatment in a number of its strategies and guidelines, and has prioritized the use of rapid tests to increase access. In Nigeria, the development of new rapid tests that can test simultaneously for both HIV and syphilis has reinvigorated interest in testing and treatment for pregnant women and newborns, especially at lower levels of care.
Congenital syphilis is an infection that touches mothers, newborns, and children as they grow and develop. Getting to zero cases of congenital syphilis globally is a lofty goal, but one that can be achieved with strong leadership and better policies and funding for testing and treatment. Country policymakers have a major role to play, as do advocates, donors, and health practitioners. The time is now to make congenital syphilis a priority.