The Health Department is issuing a Health Alert today to providers that emphasizes the importance of testing pregnant women for syphilis as infection rates rise in New York City (NYC).
The median age of women with syphilis is 26, and the women are predominantly Black or Latina (73 percent).
Mirroring overall trends in syphilis prevalence in the United States, rates of primary and secondary syphilis among NYC women have risen 36 percent from 2014 (32 cases) to 2015 (43 cases). There were 36 cases in the first six months of 2016. The median age of women with syphilis is 26, and the women are predominantly Black or Latina (73 percent). The increase in women is notable because syphilis predominately has affected men for the past 15 years.
Increases in female syphilis cases portend increases in congenital syphilis infections, because a pregnant woman with syphilis can transmit the infection to her unborn infant. Untreated or inadequately treated syphilis in a pregnant woman can lead to miscarriage, stillbirth and neonatal death. Infants with congenital syphilis can suffer from irreversible manifestations of syphilis infection, including bone deformities, deafness and other severe neurologic impairments. Congenital syphilis and its devastating complications are completely preventable. Nonetheless, over the past decade, New York City has seen about 10 congenital syphilis cases each year; there have been four cases of congenital syphilis reported in the first half of 2016. Prevention relies on early detection of unrecognized syphilis in the mother, detection of newly acquired infections during pregnancy, and ensuring maternal treatment is completed at least four weeks before delivery. To prevent increases in syphilis, the Health Department is reminding providers that they must identify and treat women with syphilis or syphilis exposure, and all pregnant women must be screened for syphilis in accordance with New York State law (at first prenatal visit and at delivery), and more frequently if a woman has a new or ongoing risk for syphilis. Screening for HIV is also recommended for any woman diagnosed with syphilis, as is offering HIV pre-exposure prophylaxis (PrEP) to women most at risk for infection.
“The increase in syphilis cases among women in New York City is concerning,” said Health Commissioner Dr. Mary T. Bassett. “Preventing syphilis remains a priority of the Department. This year, we expanded STD clinic hours and are raising awareness about the importance of getting screened for STDs and HIV. The City will continue to work with health care providers to screen and treat New Yorkers to reduce the spread of syphilis. I also encourage New Yorkers to play sure by getting tested and knowing their STD and HIV status.”
“It’s critically important that all expecting mothers get tested,” said Council Member Corey Johnson, Chair of the Committee on Health. “Especially with syphilis, symptoms can go unknown for a long time, so this is a precautionary step that can make a big difference. Under the excellent stewardship of Commissioner Dr. Mary Bassett, the Department of Health is closely tracking this infection and taking all the steps necessary to keep New Yorkers healthy and safe. Still, the best prevention happens in the doctor’s office, so I hope all New Yorkers, particularly our mothers-to-be, will go out and get tested.”
Preventing syphilis has been a focus of the Health Department’s disease prevention efforts. To help address primary and secondary syphilis, the Health Department announced in February that all eight STD clinics would offer services Monday through Friday, with Saturday hours available at the Riverside and Fort Greene locations. Expanding operations by 10 hours per week can accommodate 5,000 more patient visits per year beyond the annual total of 70,000 visits. The STD clinics are open to all New Yorkers 12 years of age and older, on a walk-in basis, and provide care regardless of ability to pay and immigration status.
Health Department staff also follow up on all positive syphilis tests from women of childbearing age in New York City to determine if the test represents a new infection or an old, treated infection, and to also ascertain pregnancy status. Health Department staff contact health care providers for any women with a new positive syphilis test to determine the stage of disease and to assure adequate treatment. Women with syphilis are then interviewed in order to elicit the names and contact details of sex partners. The Health Department reaches out to partners for syphilis testing and treatment in order to prevent women from being re-infected, and to stop the spread of disease. Pregnant women with syphilis are followed throughout their pregnancy to ensure the treatment is effective.
In addition, the Health Department reviews every case of congenital syphilis in detail to identify errors that may have occurred at any level (health care provider, testing laboratory, information transfer, public health response) and that could have contributed to a missed opportunity to prevent a case of congenital syphilis. These findings are translated into policy and procedural changes whenever possible, and the errors and suggested solutions are highlighted during provider education sessions.
These educational sessions are also used to remind health care providers about the legal requirement to screen all pregnant women for syphilis at the first prenatal visit and at delivery. Health care providers deliver Grand Rounds presentations at heath care facilities throughout the city for the purpose of training to appropriately diagnose and manage syphilis cases. When a confirmed case of congenital syphilis is diagnosed, agency staff notify the clinical leadership at the facility and present a detailed review of the case, focusing on missed opportunities for prevention.
New Yorkers should talk to their doctors about getting screened, and talk openly with their doctor about their sexual practices and potential exposure to syphilis infection. For additional information about the City’s free STD clinics, please visit nyc.gov/stdclinic.