New public health recommendations make syphilis test routine for women 45 and under – PUBLIC HEALTH INSIDER

All sexually active women under 45 in Washington state who have not had a syphilis test since January 2021 are advised to get tested for syphilis.

That’s according to a new recommendation from the Washington State Department of Health and Public Health – Seattle and King County.

There has been a nearly 5-fold increase in syphilis in cisgender women since 2015 (cisgender means gender identity matches the sex assigned at birth). This recommendation is aimed at preventing this disease in this population.

Congenital syphilis

Syphilis is a sexually transmitted infection. Congenital syphilis occurs when a fetus acquires the disease in the womb before birth. This new recommendation also seeks to reduce the increasing number of babies being born with congenital syphilis, a devastating but preventable disease.

Syphilis during pregnancy can cause miscarriage, stillbirth, premature birth, or serious birth defects. It can be prevented when the pregnant woman is examined and treated at least a month before delivery.

Congenital syphilis is relatively rare in King County, but we are concerned about the recent increase in cases. Prior to 2019, there had not been a case of congenital syphilis in King County for many years. There were three reported cases in 2019 and only one case in 2020. However, in 2021 there were 11 cases of congenital syphilis in King County. Two of the babies were stillborn and five were born prematurely. Twelve cases of congenital syphilis have occurred in King County so far in 2022, resulting in 8 premature births and 9 babies with symptoms of congenital syphilis.

Syphilis Cases (All Stages) Among Cisgender Women by Pregnancy Status, King County, WA 2007-2022

Who is at risk?

Nationally, about 40% of pregnant women with syphilis in 2021 had no risk factors at all. However, people at highest risk of giving birth to a baby affected by congenital syphilis are those who do not receive consistent prenatal care, including people who are homeless, use methamphetamine or other drugs, and trade sex for compensation.

But data show that even women without these risk factors become pregnant while infected with syphilis.

“The increase in syphilis in cisgender women and pregnant people suggests that syphilis may be spreading in the general population and among women in particular,” said Dr. Matthew Golden, director of the Seattle and King County HIV/STD Program. “Rising rates of syphilis in cisgender women and pregnant people are alarming, which is why we’re recommending that most sexually active women under 45 get tested if they haven’t by 2021, and why we’re asking providers to increase syphilis testing in pregnant women persons.”

Other states along the West Coast are making similar recommendations.

What is syphilis and how do you get it?

Syphilis is a sexually transmitted infection caused by bacteria. Early in the infection, it can cause sores on the genitals, mouth, or anus. In most cases, this eventually results in a widespread rash. However, some people have relatively mild symptoms that go away without treatment, and many people with syphilis don’t know they have it. This is why the syphilis test is so useful.

Left untreated, syphilis can cause serious complications, including stroke, blindness, and hearing loss. As described above, syphilis can also be transmitted from a pregnant person to a child.

What public health is doing about syphilis

Syphilis has been on the rise in our community for several years, especially among men who have sex with men, and public health continues to work to bring this epidemic under control.

We work to identify people, including pregnant women, at highest risk of syphilis – and treat them. We train healthcare providers to identify patients at risk, work with providers to conduct targeted screening in emergency departments, screen people in correctional facilities, and have expanded investigations, data analysis, and outreach services for people with syphilis.

The bottom row

If you are a sexually active woman under the age of 45 and have not had a syphilis test since January 2021, we recommend that you ask your doctor for a test at your next visit. Although your own risk may be low, getting tested is a simple step for peace of mind.

For more information

The Syphilis Epidemic in King County

Syphilis Facts

Syphilis is on the rise

For healthcare providers

Originally published on November 28, 2022

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