Following state and national trends, syphilis cases are on the rise in Cumberland County, including cases of congenital syphilis, in which a baby is born with the disease passed down from the mother.
Jennifer Green, director of Cumberland County Department of Public Health, described the increase as “across the board,” but especially high in women. Green said there have been babies born with congenital syphilis in the past year in Cumberland County, though there have not been any deaths reported as a result.
According to the latest data from the N.C. Dept. of Health and Human Services, there were four cases of congenital syphilis in the county in 2022. In adults, there were a total of 373 cases in 2022, including all stages of the disease. Syphilis is considered transmittable only in early stages of the disease, accounting for 227 cases in 2022. There were 146 cases of late, latent syphilis, which is not transmittable.
Syphilis is a bacterial sexually transmitted infection. The disease can have potentially severe stages causing skin lesions, neurological damage and, if left untreated, organ failure. It is primarily transmitted through direct skin-to-skin contact with infectious sores, but it can also be passed down from mother to baby.
After reaching historically low levels in the 1990s and early 2000s, syphilis has had a major resurgence in the past two decades, with an exponential increase in cases starting around 2005.
NCDHHS issued a public health alert in April that syphilis cases in North Carolina are on the rise, increasing 23% from 2021 to 2022. According to NCDHHS data, Cumberland County has one of the highest rates of syphilis in the state, with 50.1 to 75 cases per 100,000 people.
Green said there was no single factor that has contributed to the rise in cases, but rather a myriad of circumstances that have resulted in its widespread transmission. These include many people “dropping out” of the health care system during the pandemic, the opioid crisis and a national shortage of the drug Bicillin, the frontline treatment for syphilis.
“So you sort of have this perfect storm of all of these things happening at the same time that are really contributing to this increase of syphilis rate,” Green said. “Not any one thing. Otherwise, I think we'd solve it.”
Congenital syphilis
Most recently, NCDHHS issued a public health alert on Nov. 13, which warned of a rise in congenital syphilis in the state. The alert was precipitated by five stillbirths or neonatal deaths in babies with congenital syphilis born between Jan. 1 and Sept. 1 of this year. From 2012 to 2022, the alert stated, there was a 547% increase in reported syphilis cases in North Carolina among women with an associated increase in congenital syphilis infections.
Congenital syphilis is preventable, but if left untreated in pregnancy, it can result in miscarriages, stillbirth and neonatal death, as well as adverse life-long health impacts for the baby. Green said it's imperative for pregnant women to get prenatal care, which comes with a mandatory syphilis screening.
“We need people to get tested, and we need our providers’ help,” Green said. “We need our providers to make sure they're not missing opportunities when they have a patient in front of them and that everybody takes a good sexual history for all of their patients.”
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The health department, Green said, has been working to educate health care providers and raise awareness about the increase in congenital syphilis rates. A lot of this work involves educating local health care professionals about the legal requirements to test pregnant women for syphilis.
“So even before the alert went out from the state health department, one of the things that we're working to do is to educate our providers,” Green said. “So all of the providers in North Carolina are required by law to test all pregnant women for syphilis at their prenatal visit midway through, so at 28 weeks to 30 weeks, and then at delivery.”
Green said the education campaign is also targeting those with substance use disorder, who tend to be less inclined to seek medical care.
“We want to make sure that those folks also have information about the increased rates of syphilis, because we know that individuals that are with substance use disorder are less likely to get prenatal care, which means they're less likely to get tested for syphilis when they're supposed to be,” Green said. “So we want to make sure that we're doing lots of outreach and education when we're in the community.”
Prevention and protection
The use of condoms can reduce the risk of getting or giving syphilis when the condom covers the infected area or site of potential exposure. The only way to completely avoid syphilis is to not engage in sexual activity of any kind or be in a long-term, mutually monogamous relationship with a partner who does not have syphilis. However, getting screened regularly for STDs is essential for patients to receive timely treatment of the disease before it spreads.
Overall, Green encourages both health care providers and patients to be vigilant of the risk of syphilis, take precautionary measures and conduct or participate in regular STD and sexual history screenings.
“We want everybody, all of our health care providers to take a good sexual history and not just assuming, ‘Oh, this person seems young and healthy, they'll be fine’,” Green said. “We really need our providers to help us with this — and then of course, we need people to get tested as well.”
Cumberland County hosts an STD clinic that provides free services to anyone interested in the screening, diagnosis, treatment and counseling of sexually transmitted infections and HIV. All services are confidential and are provided by highly trained specialists, using the most up-to-date assessments and recommendations.
To schedule an appointment at the county’s STD clinic, call 910-433-3600. The health department is open from 8 a.m. to 5 p.m. weekdays. The clinic is located on the second floor of the Cumberland County Dept. of Public Health, 1235 Ramsey St. in Fayetteville.
Contact Evey Weisblat at eweisblat@cityviewnc.com or 216-527-3608.
