Policy Approaches to Addressing Rising Rates of Congenital Syphilis

Background:  Congenital syphilis occurs when a mother infected with syphilis transmits the infection to the fetus during pregnancy.  Congenital syphilis can cause severe illness, miscarriage, stillbirth, and infant death.  Maternal treatment for syphilis is highly effective at preventing congenital syphilis.  From 2012-2014, reported cases of congenital syphilis increased across all regions of the United States with 11.6 cases per 100,000 live births in 2014, the highest rate reported since 2001 and a 38 percent increase in just those years.  The CDC recommends testing for syphilis in the first trimester or at the first prenatal visit with additional testing at 28 weeks’ gestation for women at increased risk or live in communities with increased prevalence of syphilis.  Because of these increases, states across the country have been looking to policy changes to increase screening for syphilis in pregnant women.

Methods:  NCSD has supported efforts across the country to use policy to address increases in congenital syphilis. Efforts include a policy trend towards requiring testing in the third trimester as well as the first trimester.  Additionally, other states are attempting to address congenital syphilis increases through regulation.

Results:  States that have successfully passed bills in the last two legislative sessions include Louisiana, Texas, and Georgia.  In these states, advocates and health departments have determined that a third trimester test for syphilis should be mandated and that legislation is an appropriate way to address congenital syphilis.  States that are attempting to address congenital syphilis though not yet successfully through changing regulations include New York and Florida.

Conclusions:  This session will give an overview of the legislation that states have passed and give strategy on addressing congenital syphilis through policy—both regulatory and legislative.