Congenital Syphilis Rose in Chicago During COVID-19: Missed Chances, 2015–2022

Summary

Syphilis in pregnancy can pass to the fetus, raising the risk of stillbirth and lasting physical and cognitive harm to the baby — congenital syphilis. After the Chicago Department of Public Health (CDPH) stepped up efforts to eliminate it, including better surveillance and case management, Chicago's congenital syphilis cases fell through 2015–2019, even as they rose nationally and syphilis rose among local women.

In 2020, with COVID-19, the trend reversed: cases climbed for three years. CDPH reviewed every congenital syphilis case from 2015 to 2022 — case reports, disease intervention specialists' interview records and field notes, and medical records — to see which prevention opportunities were missed, before and during the pandemic.

What changed

• During 2020–2022, reported congenital syphilis cases rose an average of 74.1% a year — more than 3 times the rise in syphilis among females of reproductive age (15–44), 22.1% a year.
• That syphilis rate fell 9.5% in 2022 from 2021.

Which opportunities were missed

Each case was put in one of five categories:

• Inadequate treatment rose by about 80% (p = 0.007) — and climbed every pandemic year: 31.6% in 2020 (6 of 19), 40.0% in 2021 (10 of 25), 60.0% in 2022 (27 of 45).
• Late identification of infection during pregnancy jumped in 2020 only (10 of 19, 52.6%; p = 0.006), then fell back.
• No prenatal care fell as a share, but the numbers of such cases in 2021 and 2022 were the highest since 2015.

Why

• 2020's late diagnoses may reflect less testing and treatment: fewer clinic visits, closed sexually transmitted infection clinics, and telemedicine prenatal visits, where blood cannot be drawn.
• The sustained rise in inadequate treatment may come partly from public health staff diverted to COVID-19, making it harder to reach pregnant patients and see them treated. This may explain why congenital syphilis rose so much faster than syphilis among women.
• The 2022 fall in syphilis among women could be a real decline from better testing and treatment — or fewer diagnoses and underreporting.

What helps

COVID-19 remains a challenge even after the public health emergency ended. The tools Chicago used before the pandemic matter more than ever:

• provider education about congenital syphilis;
• electronic reporting;
• better identification of pregnancy among people with syphilis;
• enhanced case management for syphilis in pregnancy;
• partnerships with providers, community organizations and maternal and child health programs;
• a statewide multidisciplinary review of every congenital syphilis case.

Sources

Based on Helen E. Cejtin et al., "Notes from the Field: Diagnosis of Congenital Syphilis and Syphilis Among Females of Reproductive Age Before and During the COVID-19 Pandemic — Chicago, 2015–2022," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention (2023), by authors from Cook County Health, Northwestern University, CDC and the Chicago Department of Public Health; published by CDC. The report's table gives a pandemic total of 8 for signs of syphilis despite completed treatment, although each pandemic year shows 0 and the categories otherwise add to 89; 0 is used here.