Ohio Sees Surge in Congenital Syphilis Cases

Cases are up more than 300%

click to enlarge Ohio Sees Surge in Congenital Syphilis Cases
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In Ohio, the rate of congenital syphilis has increased more than 300%, from 22 cases in 2018 to 93 in 2022. Nationally, syphilis in newborns reached a 10-year high in 2022 with more than 3,700 cases.

According to the Ohio Hospital Association, untreated congenital syphilis can have harmful consequences, potentially leading to miscarriage, low birth weight, premature birth, and other complications.

According to the CDC, syphilis is a sexually transmitted bacterial infection transmitted through direct contact with a syphilis sore. Pregnant individuals with syphilis can pass the infection to their unborn child.

“So that goes to show us that if it's left untreated, then we can have severe complications such as infection to the brain, nervous system, eyes, hearing loss, stroke, and blindness,” said Caroline Kingori, an associate professor of community and public health at Ohio University. “The other thing is it puts someone at a heightened risk of contracting HIV. So when syphilis is untreated during pregnancy, you're putting the mother and the child at risk.”

Public health advocates say early detection and treatment of the disease is critically important to the health of mothers and babies. Syphilis can cause a wide variety of symptoms or no symptoms at all, at least for a while, so mothers may not know they’re infected — especially if they don’t have ongoing access to healthcare.

“Syphilis symptoms can be delayed,” said Fred Wyand, director of communications of the American Sexual Health Association. “They may not show up immediately, right at birth. It may take a little while. And that's also true when people acquire syphilis with these dull sexual contact symptoms that may not be immediate and then they tend to come and go. Somebody referred to syphilis as the great pretender because you can have symptoms like some skin rashes and ulcers that just clear up and go away, but it didn't. It's still there and can do some damage underneath.”

Public health advocates say the rise could be due to multiple factors, including a lack of testing and treatment. In Ohio in 2021, only 78.6% of babies were born to mothers who received early prenatal care. One in seven infants were born to mothers who received inadequate prenatal care.

Newborns of Black, Hispanic, and Native American/Alaskan Native mothers are eight times more likely to have congenital syphilis than those of white women, suggesting the disparity is linked to potential gaps in prenatal care and health insurance access within nonwhite communities.

“If you're dealing with communities that are underserved and rural, you're talking about people who don't have access to health insurance,” Kingori said. “Then the socioeconomic status includes education, employment, and if they don't have income, they're struggling. And if they don't have employment, then they also don't have health insurance. If they do, they're underinsured, and so health becomes secondary to people trying to find an opportunity to eat.”

While healthcare is crucial in preventing the transmission of syphilis to infants, experts say we also need to improve conversations and education about sexually transmitted infections (STIs).

“About half of young people will have an STD by the time they reach age 25,” Wyand said. “To think about that one out of two people, by the time they reach age 25 in this country, will have an STI. A lot of these cases are undiagnosed. But young people in that age group from the teens up to the mid-20s, bear the highest burden of STI of any age group,”

The World Health Organization emphasizes that children and adolescents have the right to age-appropriate and developmentally suitable comprehensive sexuality education (CSE) for their health and well-being.

“Raising awareness is critical,” Kingori said. “It's raising awareness and normalizing the language we associate with sexually transmitted infections. The weight that we give cervical cancer and the concern we produce for that, we should do the same with STIs, with the same empathy. It will help combat that stigma and also find ways to use non-stigmatizing language so that pregnant mothers or pregnant individuals can have access to the prevention and treatment services outside of the judgment.”

According to the Federal Office of Disease and Health Prevention, parents have the greatest impact on a young person's decisions about relationships and sex, even more than friends or the media. Open communication between parents and children leads to delayed sexual activity and a higher likelihood of making healthy choices, such as using condoms to prevent pregnancy and STIs.

“We think a real barrier to all this stuff is that we are not comfortable talking about it and we don't know how to talk about it,” Wyand said, pointing to a resource on ASHA’s website called “Be an Askable Parent.” “And that's not our fault. We're not blaming anybody. You don't know this stuff, but that's a big part of what we do and as we try to help people have these conversations and we give them practical stuff, we just don't tell them you need to talk.”
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