Syphilis Increases Among Infants

In response to higher rates of congenital syphilis, San Antonio, Texas, Metropolitan Health District officials have sent letters to Bexar County physicians to advise third-trimester screening for the sexually transmitted disease. In 2008, 11 babies delivered in the county had syphilis, including two who were stillborn. The most recent data available show five congenital cases in the first six months of 2009. Only four cases were recorded in 2007.

"We need to be proactive," says Domingo Navarro, MDH's communicable-diseases program manager. Of the 11 cases in 2008, four of the mothers had no prenatal care, though nearly all pregnant women are Medicaid-eligible in Texas. Two others had one or two visits, and the medical histories for the remainder are unknown.

"To me, the real travesty are the ones who are in care, who got that first trimester test, now they've gotten infected and they're going along thinking they're fine," says Scott Salo, MDH's head of STD outreach programs. "Boom, at the delivery we find out we've got major problems."

The congenital syphilis rate in Texas almost doubled between 2005 and 2008, and health officials are considering a statewide push for third-trimester screening.

"[Texas Department of State Health Services] staff has held informal discussions with the five largest local health departments -- Houston, Dallas, San Antonio, Fort Worth, and Austin -- about developing recommendations for third-trimester syphilis testing as part of a statewide response plan for congenital syphilis," said DSHS spokeswoman Allison Lowery. "However, DSHS has no official recommendation for third-trimester syphilis testing at this point."

A new state law that took effect January 1 requires doctors to perform first-trimester testing for HIV, syphilis, and hepatitis B unless the mother objects.