NC Medicaid and the Division of Public Health (DPH) are alerting providers to the increased prevalence of syphilis in women of reproductive age; existing standards of care include testing all pregnant women at first prenatal visit, between 28-32 weeks and at delivery; and NC state law on sexually transmitted diseases.
Congenital syphilis rates are on the rise nationwide, with the Southern United States accounting for the majority (53%) of reported cases in 2022. In North Carolina (NC), over half the births are to Medicaid-eligible women, making Medicaid a pivotal player in addressing this issue. A recent Vital Signs report from Centers for Disease Control and Prevention (CDC) highlights missed opportunities for preventing congenital syphilis.
Collaborative efforts between Medicaid and public health leaders across the Southeast are underway to develop effective strategies that address this critical issue. Congenital syphilis is preventable, but can lead to still birth, blindness, deafness, developmental delay, and more if left untreated.
On Oct. 17, 2023, payer and public health representatives from Southeastern states, along with the CDC and the Center for Medicare and Medicaid Services (CMS), convened for the Southeastern Congenital Syphilis Payer Summit (SECSPS) in Raleigh. Across the Southeast, public payers and public health officials are partnering to reverse our deadly trend in congenital syphilis.
A key outcome of the summit was highlighting the need for and implementation of a standard recommendation across the Southeast for syphilis screening in pregnant individuals at the first prenatal visit, between 28-32 weeks of gestation, and at delivery. Additionally, newborns should not be discharged from the hospital until the birthing parent’s delivery syphilis test results are known. These recommendations align with current North Carolina state law.
Syphilis rates in North Carolina have surged by 547% between 2012 and 2022. During that time, Congenital Syphilis cases have risen from one case in 2012 to 57 cases in 2022. Tragically, North Carolina has documented five still births and two neonatal deaths to date so far this year, marking an increase from zero such cases in 2022.
North Carolina health care providers across all practice settings, play a crucial role in reducing the rates of congenital syphilis. It is critical that medical professionals caring for pregnant individuals in any setting be mindful of the risk of congenital syphilis and act accordingly.
- Clinicians should complete a sexual health history for all patients to identify risks. They should offer and normalize STI screening, including syphilis screening, for all sexually active people aged 15-44 years of age.
Clinicians should follow North Carolina state law by conducting routine universal screening at least three times during pregnancy, regardless of perceived risk or county specific rates of syphilis. Syphilis screening in pregnant individuals should be performed:
- At the first prenatal visit, and
- Between 28-30 weeks of gestation, and
- At delivery
Providers should also screen more frequently if clinically indicated, or if a patient requests to be screened, regardless of healthcare setting (e.g., emergency department, urgent care, primary care). Due to the high prevalence of infections at this time, at any prenatal visit, if the provider is not able to verify prior syphilis testing in pregnancy, per recommendations, they should consider testing.
- When a person is diagnosed with syphilis, clinicians should ensure sex partners are treated to prevent re-infection, especially during pregnancy. TellYourPartner.org is a national website that allows individuals to confidentially and anonymously notify their own sex partners.
- Laboratories and clinical providers should immediately report syphilis and congenital syphilis infections to your local public health department.
- Hospitals should not discharge newborns until the birthing parents' delivery syphilis testing results are known, in accordance with North Carolina state law.
SECSPS leaders provide the following recommendations for hospitals to optimize testing and management of results prior to hospital discharge.
| Solution | Pros | Cons | Rating |
|---|---|---|---|
| Lab provision of testing 7 days a week | Daily results available | Cost Staffing | Best |
| Offer Reverse Algorithm from Traditional Testing (e.g., CDC Reverse Algorithm) | Faster (ability to batch) Lower Cost | Staff training/re-training | Best |
| Offer Point of Care Tests (if no known history of syphilis) | Rapid turnaround Low cost | CLIA license required Follow-up blood draw required if positive | Best |
Adopt Hospital Policy for Standard of Care to identify at risk babies upon discharge:
| Standardizes work and expectations Creates impetus for change | Can be time consuming and variable in the absence of standard guidance | Best |
| Require signing Against Medical Advice (AMA) form if disregarding North Carolina state law because the patient is unwilling to wait for test result prior to discharge Create flag in birthing parent’s chart if syphilis results not on chart at discharge Outreach should be made to the payor maternity case management team to assist with follow up if birthing parent leaves before test done/resulted | Reinforces shared decision making | Nonbinding | Fair |
The Southeastern coalition is working diligently to strategize and implement best practices to combat the congenital syphilis crisis which is uniquely impacting this region of the country. Together we can reduce the rates of congenital syphilis and its devastating consequences in our communities!