These trends have combined to affect “women from vulnerable communities…typically black or brown women, with low financial means, lack of access to transportation, [and] inability to take time off work,” says Natasha Bagdasarian, a physician and medical director for the state of Michigan, which has recorded 38 congenital cases of the disease in 2022. “What we see when we look at cases of congenital syphilis, these are people who, rather than using a single health care provider throughout their pregnancy, went to the emergency room or emergency room, or saw one doctor and then switched to another due to life circumstances.
A study presented Sunday, Nov. 12, at the American Public Health Association annual meeting in Atlanta showed who are the most vulnerable women, using state hospital discharge data, which contains diagnosis codes for insurance billing. In Mississippi, 367 infants were born with congenital syphilis between 2016 and 2022, according to Manuela Staneva, an epidemiologist at the Mississippi State Department of Health; there were 10 cases in 2016 and 110 in 2022, an increase of 1,000 percent. Among the mothers, 93 percent were on Medicaid, indicating they were poor; 58 percent lived in rural areas; and 71 percent were black — a sign of race’s unequal influence on health, as the state’s population is only about 38 percent African American. (This data was also recently published In Emerging infectious diseases.)
“This is the price babies pay,” Staneva said in her presentation. “It’s quite worrying.”
Currently, most states require women who visit the doctor while pregnant to be tested for syphilis at least once. Some jurisdictions, including New York, require testing in the third trimester in addition to testing in the first trimester. Mississippi instituted first and third trimester screening Last March, just months after its health department, including Staneva, began investigating congenital syphilis. Always, a handful Some states do not have such laws.
Yet mandating testing has not solved the problem nationwide, because the syphilis testing process does not reflect the reality of marginalized women’s lives. The gold standard for detection is to take a blood test, send it to a lab, receive the results several days later, and then take the woman back to her doctor for an injection. That’s more aftercare than some women can handle. “There are times when we test someone and it can take more than a week for the results to come back,” says McDonald, who sees patients in Atlanta. “It’s really difficult to find people: they’ve forgotten their concerns, other things have happened in their lives, sometimes their phone is disconnected.”