Mississippi is leading the country in syphilis cases, resulting in a tragic uptick of newborns risking death from the disease across the state.
Mississippi has had a more than 900% increase in babies born with syphilis – a sexually transmitted disease that is also passed to an infant during pregnancy – in six years ending in 2021. Syphilis can cause miscarriages and death. Surviving children born with the disease can have major malformations and life-long complications.
The Centers for Disease Control and Prevention reported preliminary data that 2,677 babies nationwide born with congenital syphilis in 2021. It was the highest number reported in one year since 1994. Case counts have been rising steadily since 2013.
“It’s absolutely alarming and shocking,” said former State Health Officer Dr. Thomas Dobbs, “and it’s totally preventable.”
Dobbs now leads the University of Mississippi Medical Center’s School of Population Health. He and other leading health care officials in the state are trying to warn parents and colleagues about the growing problem.
“Years past, it was a rare and uncommon event (at Forrest General Hospital), where we had a couple babies per year with congenital syphilis,” said Dr. Anita Henderson, a pediatrician at The Pediatric Clinic in Hattiesburg. “Now, we are seeing babies on a monthly, sometimes weekly basis, who test positive from mothers who received partial treatment, or no treatment.”
Syphilis is treated effectively with penicillin. Despite a simple cure, Mississippians are continuing to contract and pass along the illness with dire consequences.
In 2016, eight babies in Mississippi were born and hospitalized with syphilis. In 2021, that number hit 106, according to data Dobbs shared based on health department and hospital discharge numbers. While syphilis cases in infants have gone up nationwide, Mississippi’s rate of increase is nearly five times the national average.
“The numbers are bad,” said Dr. Charlotte Hobbs, a professor of pediatric infectious disease and microbiology at UMMC, “and they’re just going to get worse.”
Mississippi is tied with Nevada for the leading rate of overall cases of syphilis per population of 100,000.
Most states require syphilis screenings in pregnancy by law, but Mississippi is one of six that doesn’t. Without mandatory screenings, some mothers are shocked to learn they even have the disease. They may not have symptoms, and by the time they do find out, it’s sometimes too late.
State Epidemiologist Dr. Paul Byers said in a statement the health department is exploring the possibility of a regulation requiring syphilis testing during pregnancy.
“The messaging isn’t always clear,” Hobbs said, “but syphilis can kill your baby and it can kill you.”
Henderson said it largely comes down to a lack of sexually transmitted disease education. Sometimes those who have syphilis don’t realize a single dose of treatment isn’t enough to eradicate the infection and they need multiple doses. Maybe they were treated, but their partner never was, and they got reinfected.
“I do think they are surprised to learn syphilis can cause problems with the baby,” Henderson said. “Syphilis is easily treated … so it is not something people think about a cause of death in children in 2023. But we have had several babies die and many other suffering long term issues.”
Dobbs said poorer women – usually women of color – especially struggle to access prenatal health care. Nearly 71% of the babies born and hospitalized with syphilis in Mississippi in 2021 were Black, according to data provided by Dobbs. It’s another example of the state’s alarming health care disparities in treatment of the Black population in Mississippi.
Transportation is a major barrier. OB-GYN offices can be a long haul from rural portions of the state, and county health clinics are dealing with major nursing and staff shortages. County health clinics may offer free syphilis screenings, but nine locations have closed in recent years, and more have reduced their hours.
“We don’t have a comprehensive support network where women are accessing prenatal care,” Dobbs said.
He sees that as the largest barrier. Another comes with how difficult it is for expecting mothers and parents to access health care in general, especially under Medicaid. That’s why doctors across Mississippi are pushing for the state’s Medicaid coverage to include presumption of eligibility during pregnancies. A bill in the House that would have sped up access to care for mothers at lower income thresholds during pregnancy already died this session.
It’s not uncommon for an expecting mother to wait more than a month before their public health insurance is approved after they become aware of their pregnancy. That public health insurance covers about 65% of the state’s pregnancies.
Doctors offices often won’t see pregnant patients until they have their coverage card in hand – which could mean missing out on penicillin treatments in the first trimester, when outcomes would be the most favorable.
Penicillin treatments, though relatively simple, are pricey. Doctors’ offices often don’t want to take on that expense without the assurance they will be paid back.
“Women of a reproductive age need to have regular health care to have proper family resources,” Dobb said. “Women should be empowered to time births consistent with their desires, with the counseling of physicians.”
But in Mississippi that access often isn’t easy to come by. Dobbs said the syphilis outbreak is a reflection on the depletion of Department of Health resources.
“If your health department doesn’t have anybody in them, you can’t get tested or treated,” Dobbs said. “Those are the bread-and-butter pieces of syphilis control. Over the past two decades, public health has deteriorated remarkably.”
Now, an increasing number of children in Mississippi are living with the consequences.