The number of babies born infected with syphilis increased in Colorado last year, but not by as much as state officials feared when they sounded the alarm in April.
The 2024 statistics aren’t finalized yet, but it appears about 60 babies had congenital syphilis, which means they got the infection during pregnancy or at birth. The number of cases had increased sharply over the previous five years, from seven in 2018 to 51 in 2023.
“What it’s looking like is a stabilization” and, hopefully, a decline will follow, state epidemiologist Dr. Rachel Herlihy said Friday.
In April, the Colorado Department of Public Health and Environment issued an order requiring health care providers to offer testing to patients in the first trimester and third trimester, when they gave birth, or if they suffered an infant death or stillbirth after 20 weeks of pregnancy. (Miscarriages in early pregnancy are common, but later losses are rarer and may point to a medical problem for the mother.)
At the time, Colorado had recorded 25 cases, including seven infants who were stillborn or died within months of birth from complications of the infection, and Herlihy said that the state could have more than 100 cases if nothing changed.
Babies have the best chance of avoiding complications from syphilis if their mothers get treatment at least 30 days before their birth, said Dr. Sara Saporta-Keating, associate medical director of infection prevention and control at Children’s Hospital Colorado. Someone with a new infection typically needs only one shot of antibiotics, while people who have had the disease longer need three.
Without treatment, the bacteria invade most parts of the body, causing severe inflammation that eventually results in disability or death, Saporta-Keating said. Some babies clearly are sick at birth, while others appear healthy but later show damage to their brains, eyes, ears or bones.
“The goal is to treat them before they have any (negative) outcomes,” she said.
While 50 or 60 babies represent a small fraction of all children born in Colorado, the state needs to keep focusing on identifying and treating parents because of the severe consequences, Saporta-Keating said.
“Those are 50 babies that wouldn’t have had to have a 10-day stay in the ICU,” which is standard for those not treated before birth, she said. “This is a preventable disease, and if we can keep 50 babies from having to go through that, I think it’s worth it.”
Previously, Colorado required health care providers to offer syphilis testing during the first trimester, or whenever the patient started prenatal care.
Last session, lawmakers directing the state Board of Health to come up with permanent rules for syphilis testing during pregnancy. , which took effect Jan. 14, are essentially the same as those set in last year’s public health order.
Around the same time that state health department issued its order, the American College of Obstetricians and Gynecologists released new guidance, calling for providers to test patients twice during pregnancy and at birth. Some patients who test negative or get treatment early in pregnancy get infected again, particularly if their partners haven’t received antibiotics.
Hopefully, universal testing will reduce the stigma associated with looking for a sexually transmitted infection and encourage more patients to agree, Saporta-Keating said.
“We need to normalize this testing,” she said.
In the latter decades of the 20th century, syphilis mostly circulated in gay and bisexual men’s sexual networks, and cases in women and infants were rare. That changed in roughly the last 15 years, and syphilis infections in women of reproductive age increased seven-fold from 2012 to 2021, .
The disease first started to resurge in southern Colorado, and the state health department initially focused on expanding testing and treatment in Pueblo and El Paso counties, Herlihy said. Those counties’ share of congenital syphilis has dropped, and now public health officials are expanding their focus to include the Denver area, where infections rose more recently, she said.
In the first half of 2024, about 1,700 people in Colorado received a syphilis diagnosis. Almost 40% of them were women.
Condoms and safer sex practices can help reduce the spread of syphilis, but the most effective prevention is to cure people who have it, so they won’t inadvertently infect future partners, Herlihy said.
Until the last few years, a mere handful of cases would have been a “public health crisis,” and current levels would have been unimaginable, both because of the devastating effect on babies and because they should be easily preventable, Scott Bookman, senior director of public health readiness and response at the state health department, told the legislative joint health committee last week.
To bring infections back under control, the department has mandated testing in jails and emergency rooms, and partnered with local organizations to bring antibiotic shots to women and their partners if they aren’t likely to come into a clinic, he said.
“I want everybody thinking about it. I want everyone talking about it. We are literally saving the lives of babies,” he said.
