Congenital Syphilis, a Growing Threat to Alaska Babies
Congenital syphilis is on the rise because the bacteria that causes it is passed from the mother to the developing fetus. Syphilis is transmitted through sexual contact and if left untreated, it can cause neurological and musculoskeletal disabilities or even fetal death.
A report from the Alaska Department of Health published in the state’s Epidemiology Bulletin, number 9, last August 2, warns of an increase in cases of congenital syphilis in newborns.
The epidemiological bulletin is led by Department of Health Commissioner Heidi Hedberg, Medical Director Anne Zink, and Division of Public Health Director, Lindsey Kato. According to health officials, 26 cases of congenital syphilis linked to birth certificates or fetal death records were identified in Alaska between 2018 and 2022. Of those 26 cases, one involved an infant who died after 28 weeks of pregnancy (about seven months) but before or during delivery.
The report states that “in 2021, the incidence rate in Alaska was 54 per hundred thousand live births, while in the United States it was 78 per hundred thousand” (a lower average). In 2022, however, the incidence in Alaska more than doubled to 119 cases per 100,000 live births (U.S. data were not available). All these cases were born in a hospital, and their mothers were between the ages of 16 and 37. Most were residents of Anchorage.
Factors among mothers of congenital syphilis cases included limited (fewer than four visits) or no prenatal care (PNC) in 20 of 26 mothers (80%), substance use, and housing instability. Most mothers (18 of 26 cases, 69%) reported heroin, amphetamine, methamphetamine, or cocaine use within 12 months of case examination, and 42% (11 of 26 cases) experienced homelessness or housing instability.
In 2022, 42% of cases (5 of 12 total) received no prenatal screening visits, and 75% (9 of 12) received fewer than four visits.
The state of Alaska requires patients to undergo a syphilis serologic test during their first prenatal care visit (APN) unless they do not consent. The law does not require further testing at subsequent prenatal care visits. However, the large proportion of congenital syphilis cases among mothers who receive little or no prenatal care suggests that at least two serologic tests should be performed during prenatal care.
Although no inherent aspect of maternal race or education creates risk, disparate social conditions surrounding these factors, such as housing instability and substance use, may be contributing risk factors. Further investigation of these cases of congenital syphilis should examine the factors and conditions that influence access to appropriate prenatal care to ensure early detection during pregnancy.