Wisconsin is having a spate of congenital syphilis cases, so much so that Wisconsin’s Department of Health Services issued a memo to healthcare providers, including health departments and tribal health clinics, about the need to test pregnant people for the bacteria that causes the infection. The memo indicates that “The number of congenital syphilis cases increased from 2 cases in 2019 to 29 cases 2022” and states that “Because of the increase in cases statewide, Wisconsin Department of Health Services (DHS) requests your assistance with detecting, reporting, and treating patients, especially pregnant patients, with syphilis.” (DHS)
For overall cases of syphilis across the state (for everyone, not just babies), numbers increased 19% from 2021 to 2022, but they’ve more than tripled from 2019 to 2022 – from 585 to 1,916. We can all agree that that’s a huge increase…but can we all agree that it’s worthy of all this attention, especially when Fetal Alcohol Spectrum Disorders (FASDs) are getting no attention?
Let me go on a tangent here: I cringe every time someone complains about the cost of insulin in comparison to “free” NARCAN, as though we can only choose one medication to help only one group of people. That’s so far from the truth as to be ridiculous, and this situation is the same. We CAN address both congenital syphilis and FASDs because both deserve interventions.
In 2021, there were 61,781 live births in Wisconsin; given the low estimate that 5% of the population is born with an FASD, that means that over 3,000 of those newborns had FASDs, but only a very small fraction of them were diagnosed – because we’re not looking for it. We could be. We could use umbilical cord testing to determine if a baby is born with alcohol in its system, giving that newborn earlier access to interventions if needed.
Alcohol use during pregnancy can cause birth defects and developmental disabilities as well as problems with pregnancy such as miscarriage, stillbirth, and prematurity. (CDC)
The syphilis infection occurring during pregnancy can cause serious health problems as well as problems with pregnancy such as miscarriage, stillbirth, and prematurity. (WPR)
Are you noticing anything, or is it just me?
The Wisconsin Department of Health Services has asked all health care providers to order or test all pregnant people for the bacteria that causes syphilis. They should be screened three times during pregnancy: the first trimester, especially if patients have no insurance or have other barriers to healthcare; at 28 weeks of pregnancy; and at delivery. “Providers are implored to not discharge any patients who recently gave birth and their neonate until the test results are documented and any necessary treatment is provided or begun.” (DHS)
Wisconsin DHS is recommending that neonates be tested for syphilis when any of the following occur for the pregnant person: exposure to any sexually transmitted disease; exchanging sex for money or drugs; injection drug use. Further, “Neonates born to patients whose syphilis status is reactive or unknown at the time of delivery should also be tested for syphilis by using a blood draw on the infants’ heel.” (DHS)
On the other hand, when any of the following occur, neonates are generally tested for illegal drugs…so here’s the first problem – ILLEGAL drugs, not legal ones, as though the legal ones don’t affect outcomes for newborns: history of maternal drug use or agitated/altered mental status in the mother; no prenatal care; unexplained placental abruption; unexplained CNS complications in the newborn (seizures, intracranial hemorrhage); symptoms of drug withdrawal in the newborn (tachypnea, hypertonicity, excessive stooling/secretions); or changes in behavioral state of the newborn (jittery, fussy, lethargic). (NCBI)
One in twenty – the number of babies born with FASDs – is not rare, yet our healthcare systems act as though there’s nothing that can be done about babies born with alcohol in their systems, just because we don’t have a pharmaceutical response to mitigate the effects.
We can – and should – be doing better.
References
https://www.cdc.gov/ncbddd/fasd/features/key-finding-acer.html
http://www.dhs.wisconsin.gov/dph/memos/communicable-diseases/2023-06-bcd.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139193/
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