BATON ROUGE – Syphilis among infants in the state is on the rise again, and the Louisiana Department of Health (LDH) is working to combat this by increasing the screening opportunities for expectant mothers.
The five-year average of congenital syphilis cases in Louisiana nearly doubled between 2019 and 2023, reaching 93 cases per year. Congenital syphilis is when a pregnant woman who is infected with syphilis passes the infection to her baby during pregnancy.
The LDH is starting a new congenital syphilis pilot program to increase opportunities to screen pregnant women for syphilis. According to LDH, of the congenital syphilis cases in 2022, the most missed care opportunity of expecting mothers was the lack of timely syphilis retesting in the third trimester.
There were 115 cases of congenital syphilis in 2022, the LDH reports. Of those cases, seven resulted in stillbirth or early infant death.
Current CDC recommendations are for screening during the first trimester, third trimester and at delivery if the mother lives in a high-risk area, said Dr. Stephanie N. Taylor, medical director of Louisiana Office of Public Health STD/HIV/hepatitis program. LDH’s pilot program would offer more screening than the CDC recommends.
“Our goal is at every prenatal appointment – for women at a particular site – that, in addition to their regular blood draw, we do a rapid test for syphilis, so that if they acquire syphilis between that first trimester and third trimester, we will pick up that infection,” Taylor explained.
If syphilis is found during this time, providers will be able to offer women treatment, which is something that often hasn’t occurred whenever a woman does not receive third trimester screening. If a mother can receive treatment within 30 days of delivery, the infant will not have congenital syphilis, Taylor said.
Currently, the pilot program will be implemented at a handful of Louisiana locations:
- Woman’s Hospital (Baton Rouge)-LSU OB/GYN clinic
- Ochsner LSU Health-Monroe Medical Center
- Our Lady of Lourdes Midwifery Clinic in Lafayette
All women who are patients at these locations will be automatically tested during their prenatal visits, unless they choose to opt out.
After six months, the LDH will assess the effectiveness of the pilot project in reducing congenital syphilis cases and determine whether the pilot is feasible for expansion to providers across Louisiana, Taylor said.
She said that within six months, they will be able to see how effective more frequent screening is and how many new cases are found between the first and third trimester. In the past, similar programs have been effective, she added, and she expects that this will once again help push back the rate of syphilis in infants.
This isn’t the first time that Louisiana has seen a similar congenital syphilis concern.
In 2014, the Louisiana Legislature mandated that doctors offer syphilis screening during the first prenatal visit and again in the third trimester per Louisiana Act 459. However, according to LDH, data indicates that even with this policy, there are missed opportunities.
About 80% of mothers linked to congenital syphilis cases received prenatal care, but there were missed opportunities for screenings during their care, including a test at delivery (if the mandated screenings did not occur). Also, nearly 50 percent of all mothers linked to congenital syphilis cases did not receive the third-trimester opt-out screening required under the 2014 law, LDH reported.
While things had started to look better for a few years due to some LDH programs in place, COVID-19 interrupted the progress. Cases were no longer decreasing, but increasing again.
“Now we’re putting these programs back in place and, and we will see a decrease in the number of cases based upon our history of other programs in the state,” Taylor said.
How syphilis can impact infants
Infants who have congenital syphilis can face a range of issues. A baby born to a mother with untreated syphilis could be stillborn or die from the infection very young. There are other issues that can develop as newborn or later on in life – some less serious such as skin rash or sores to more serious effects like blindness or deafness, meningitis, psychological issues, bone and teeth concerns, among many others.
Women are also at a higher risk for miscarriage when untreated for syphilis.
“Diagnosing cases early and getting women treated can prevent some of these serious complications and infant death,” Taylor said.
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