Health Advisory

Summary

• A substantial increase in congenital syphilis cases has occurred in recent years in the Fairfax Health District, with a case identified in 2023 resulting in a fatality. The rise in congenital cases parallels a local increase in syphilis cases overall and an increase in congenital syphilis statewide.
• Rigorous adherence by providers to timely diagnosis and treatment for all pregnant patients according to CDC guidelines (see below) is required to prevent congenital syphilis.

Suggested Actions

1. TALK about sexual health history with all patients as part of routine medical care.
   • See: Provider guide on taking a sexual history
2. TEST ALL pregnant patients for syphilis:
   • During first trimester or initial prenatal visit.
   • Re-screen early in third trimester (28-32 weeks gestation) AND at delivery for high-risk patients (drug misuse, any STI during pregnancy, multiple partners, a new partner, partner with STI).
   • At delivery for patients without prenatal care or previous screening.
   • At delivery of stillborn infant (greater than 20 weeks gestation).
   • All patients testing positive for syphilis also should be tested for HIV.
3. TREAT syphilis correctly.
   • Treatment regimen depends on the stage of syphilis infection.
     • Assess for signs and symptoms in last 12 months to determine if early or late syphilis. See stage details.
   • Treatment guidance: 
     • Benzathine penicillin G is the only recommended treatment during pregnancy.
     • Late syphilis is treated with 3 doses exactly 7 days apart.
       • Pregnant patients who miss any doses must repeat the full course of therapy.
     • Patients who are allergic to penicillin must be desensitized and treated with benzathine penicillin G.
   • Consult with the health department at 703-246-2433 if you are having trouble obtaining benzathine penicillin G or if your patient has expressed concerns being able to afford treatment.
4. REPORT all early syphilis diagnoses and any syphilis diagnosis among a pregnant patient to the Fairfax County Health Department as soon as possible.
   • Online reporting
   • Phone reporting: 703-246-2433
   • Fax reporting: 703-653-1347
5. INFORM patients testing positive for syphilis to expect to be contacted by the health department.
   • Public health staff will provide health education and counseling, ensure all patients testing positive are treated appropriately, and offer partner services including testing and treatment.

Additional Information

• Congenital syphilis is a preventable condition caused by untreated syphilis during pregnancy, with potentially severe consequences for infected infants.
• Increases in congenital syphilis are occurring locally, statewide, and nationally. From 2018 to 2022, eight congenital syphilis cases were reported in the Fairfax Health District compared with no cases from 2010 to 2017. All infants were successfully treated, with no identifiable impacts from infection at the time of public health involvement. However, in 2023, the first congenital syphilis case reported led to a stillbirth.
• Statewide, 20 congenital syphilis cases were reported in Virginia in 2022, the most in three decades. This followed several years of increases in cases in parallel to a rise in early syphilis diagnoses among women of reproductive age (15-44 years) in Virginia communities, including Fairfax. These increases have disproportionately impacted Black/African American and Hispanic communities.
• More than 34% of mothers of infants diagnosed with congenital syphilis in Virginia had late or no prenatal care. Substance use during, or the year prior to, pregnancy was reported in 11% of cases.

Resources

Centers for Disease Control and Prevention

• Syphilis Treatment Guidelines 
• National Data

Virginia Department of Health Health

• Professional Resources

Fairfax County Health Department

• Diseases and Conditions