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November 11, 2019

Ending Congenital Syphilis

Author Affiliations
  • 1Baylor College of Medicine, Houston, Texas
  • 2Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
  • 3McGovern Medical School at the University of Texas Health Science Center at Houston
JAMA. 2019;322(21):2073-2074. doi:10.1001/jama.2019.17031

Syphilis was the first recognized sexually transmitted disease. Historically, syphilis affected not only the poor but also the famous and affluent.1 The discovery of penicillin by Alexander Fleming in 1928 provided an effective cure for syphilis, leading to a substantial decrease in rates of infection. With national programs dedicated to elimination efforts, the US rate of primary and secondary syphilis decreased to 2.1 cases per 100 000 population in 2001, the lowest rate since 1941.2 In recent years, rates of syphilis have increased across racial and ethnic groups, disproportionately affecting black individuals primarily in the western and southern regions of the United States.2 From 2013 to 2018, rates of early syphilis (primary, secondary, and early latent) among women of reproductive age (15-44 years) increased from 2.5 to 15.1 per 100 000 population, reflecting an increase in cases from 3386 to 9651 per year (Elizabeth Torrone, PhD, MSPH; Centers for Disease Control and Prevention [CDC]; written communication; October 14, 2019). With the inclusion of late-stage syphilis (late latent/unknown duration), cases among women in this age group increased from 7870 to 18 440 per year. Of note, changes in rates among all women were similar.2 The increase in syphilis among women of reproductive age is of particular concern because of the associated increase in the rate of congenital syphilis, from 9.2 cases per 100 000 live births to 33.1 per 100 000 live births, reflecting an increase in cases from 362 in 2013 to 1306 in 2018.2

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