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Syphilis in Infants Reaching Epidemic Proportions


Pregnant woman

By Mark Pelletier, MSN, RN, Chief Operating Officer and Chief Nursing Officer

This week, the Centers for Disease Control and Prevention (CDC) published preliminary data showing nearly 2,100 cases of newborn, or congenital, syphilis in 2020. Rates are increasing across the country in this disease that was considered eliminated 20 years ago.

When left untreated, syphilis can cause:

  • skeletal abnormalities
  • liver problems
  • prematurity
  • deafness
  • blindness
  • stillbirth

Syphilis is a sexually transmitted disease and, when it’s passed from a mother to baby during pregnancy, it’s referred to as congenital syphilis. There is an antibiotic cure for syphilis but it must be administered immediately after birth.

In 2010, only 29 states reported one or more cases of congenital syphilis. Ten years later, 47 states and the District of Columbia reported one or more cases each year; in 2020, more than 100,000 cases of syphilis were reported. These rising numbers reflect the reality of the nation’s greater syphilis epidemic as reported in a Health Affairs blog

Prenatal Care Crisis
While it’s very important to prevent syphilis among the general adult population, we need to take action now to ensure expectant mothers get the care needed to prevent syphilis. Experts are attributing this crisis to the lack of prenatal resources, including:

  • basic prenatal care
  • drug abuse
  • syphilis screening occurring too late in pregnancy or not at all

Applicable Joint Commission Requirements
The Joint Commission does have requirements to address this issue (effective July 1, 2018): 

 14        For hospitals that provide obstetric services: Upon admission to labor and delivery, the mother’s status of the following diseases (during the current pregnancy) is documented in the mother's medical record:

  • Human immunodeficiency virus (HIV)
  • Hepatitis B Group B Streptococcus (GBS)
  • Syphilis          

15        For hospitals that provide obstetric services: If the mother had no prenatal care or the disease status is unknown, testing for the following diseases is performed and the results documented in the mother’s medical record:

  • Human immunodeficiency virus (HIV)
  • Hepatitis B Group B Streptococcus (GBS)Syphilis

Note: Because GBS test results may not be available for 24–48 hours, hospitals may consider the administration of prophylactic antibiotics to the mother based on CDC guidelines: Prevention of Perinatal Group B Streptococcal Disease
16        For hospitals that provide obstetric services: If the mother tests positive for human immunodeficiency virus (HIV), hepatitis B, group B Streptococcus (GBS), or syphilis when tested in labor and delivery or during the current pregnancy, that information is also documented in the newborn’s medical record after delivery.

It's worth repeating that this is a curable disease. Even one birth with syphilis is too many. Let’s do what we can to get more women into the prenatal system faster and start the appropriate screening!

Mark G. Pelletier, RN, MS is the chief operating officer, Accreditation and Certification Operations, and chief nursing executive for The Joint Commission. Prior to his current position, Pelletier served as the executive director for the Hospital Accreditation Program and was also responsible for business development in the Hospital, Critical Access Hospital and Laboratory accreditation programs. Mr. Pelletier has more than 30 years of experience in hospital operations, performance and quality improvement, process redesign, and program development. Previously, he was the senior vice president and chief operating officer of Condell Medical Center, Libertyville, Illinois. He has also served in executive positions for several hospitals in the Chicago area including Resurrection Health Care, Northwestern Memorial Hospital, Children’s Memorial Medical Center and Mercy Hospital Medical Center.