The New York City Health Department issued a health alert today to providers that emphasizes the importance of testing pregnant women for syphilis as infection rates rise in New York City (NYC). Mirroring overall trends in syphilis prevalence in the United States, rates of primary and secondary syphilis among NYC women have risen 36 percent from 2014 (32 cases) to 2015 (43 cases). There were 36 cases in the first six months of 2016. The median age of women with syphilis is 26, and the women are predominantly Black or Latina (73 percent). The increase in women is notable because syphilis predominately has affected men for the past 15 years.
Increases in female syphilis cases portend increases in congenital syphilis infections, because a pregnant woman with syphilis can transmit the infection to her unborn infant. Untreated or inadequately treated syphilis in a pregnant woman can lead to miscarriage, stillbirth and neonatal death. Infants with congenital syphilis can suffer from irreversible manifestations of syphilis infection, including bone deformities, deafness and other severe neurologic impairments. Congenital syphilis and its devastating complications are completely preventable.
Nonetheless, over the past decade, New York City has seen about 10 congenital syphilis cases each year; there have been four cases of congenital syphilis reported in the first half of 2016. Prevention relies on early detection of unrecognized syphilis in the mother, detection of newly acquired infections during pregnancy, and ensuring maternal treatment is completed at least four weeks before delivery.
To prevent increases in syphilis, the Health Department is reminding providers that they must identify and treat women with syphilis or syphilis exposure, and all pregnant women must be screened for syphilis in accordance with New York State law (at first prenatal visit and at delivery), and more frequently if a woman has a new or ongoing risk for syphilis. Screening for HIV is also recommended for any woman diagnosed with syphilis, as is offering HIV pre-exposure prophylaxis (PrEP) to women most at risk for infection.
“The increase in syphilis cases among women in New York City is concerning,” said Health Commissioner Dr. Mary T. Bassett. “Preventing syphilis remains a priority of the Department. This year, we expanded STD clinic hours and are raising awareness about the importance of getting screened for STDs and HIV. The City will continue to work with health care providers to screen and treat New Yorkers to reduce the spread of syphilis. I also encourage New Yorkers to play sure by getting tested and knowing their STD and HIV status.”
“It’s critically important that all expecting mothers get tested,” said Council Member Corey Johnson, Chair of the Committee on Health. “Especially with syphilis, symptoms can go unknown for a long time, so this is a precautionary step that can make a big difference. Under the excellent stewardship of Commissioner Dr. Mary Bassett, the Department of Health is closely tracking this infection and taking all the steps necessary to keep New Yorkers healthy and safe. Still, the best prevention happens in the doctor’s office, so I hope all New Yorkers, particularly our mothers-to-be, will go out and get tested.”