When High Healthcare Expenditure is Irrelevant to Mother and Child

One would think that the country with the highest per capita expenditure on healthcare in the world, would provide the utmost care for their pregnant women. Unfortunately for the United States of America, this is not the case. While humanity has developed ways to prevent and treat most sexually transmitted diseases (STD’s) in existence, we’re seeing an alarming increase in STD rates as of late. In fact, according to the latest STD national overview from the Centers for Disease Control (CDC), the US experienced a 147% increase in syphilis rates, and a 254% increase in congenital syphilis both between 2016 to 2020.

What is syphilis?

The origins of this archaic disease have been argued as far back as 3000 BC, with the most commonly believed theory placing it in the 1400’s. All this to say, syphilis has been extensively studied based on how long it’s been around, and it’s completely treatable.

According to the World health Organization (WHO), Treponema pallidum causes the bacterial infection known as Syphilis. Additionally, this STD is transmitted through sexual contact with infectious syphilitic lesions, blood transfusion or from a pregnant woman to her fetus (known as congenital syphilis). The common symptoms include:

• Painless chancres at the site of infection
• Condyloma lata: large, raised, gray or white lesions which develop in moist areas
• fever
• swollen lymph nodes
• sore throat
• patchy hair loss
• headaches
• weight loss
• muscle aches
• fatigue

Is it treatable?

Through treponemal tests including P-PA, various EIAs, chemiluminescence immunoassays, immunoblots, and rapid treponemal assays, syphilis can be detected and completely treated. The CDC recommends Benzathine penicillin as a treatment for syphilis including congenital syphilis, with a reported 98% success rate when it comes to preventing transmission of the STD to the baby. Furthermore, treatment for the prevention of congenital syphilis is known to be effective even up to five months into a mother’s pregnancy.

What is the awareness level of this STD like for mothers in the United States?

Evidently, the rising rates of congenital syphilis would point to poor awareness of this STD across the US. On the contrary, all but four states seem to have laws regarding the mandatory screening for syphilis in pregnant women. For reference, here is an example of an awareness campaign for congenital syphilis used in Georgia:

So then why are STD rates still rising especially for congenital syphilis?

If states are requiring screenings for STD’s and raising awareness through initiatives; why are congenital syphilis rates still on the rise? We can relate these inquisitions to health inequities in the United States.

The highest rates of congenital syphilis were observed in minority women with low socioeconomic status. Many women in these communities oftentimes do not receive appropriate sexual or reproductive health education or understand the importance of testing in prenatal care. Additionally, it’s important to note that the African-American community is still facing the repercussions from the Tuskegee studies which created a mistrust with the healthcare system, specifically with sexual health. Moreover, many expecting women do not have access to affordable STD tests and screening, the means to get to locations that offer these services, insurance, or trusted providers. These factors could cause minority women to refuse STD screenings or opt-out of prenatal care.

What can we do?

As students interested in public health, or anyone with concern for the health of future generations, we must observe the case of the United States and examine why STD rates are rising, even with the availability of a cure.             On the graphic to the right we can examine the missed prevention opportunities regarding congenital syphilis, and determine that many cases were due to untimely testing or lack of treatment. We must ask ourselves what the reasoning behind these disappointing rates are and seek to work towards more equitable healthcare systems that can support healthier generations. What is screening like in other countries? To what extent do social determinants of health affect congenital diseases? Does a countries higher health expenditure correlate to their good health?

Bibliography

1. Nelson, R. (2022). Congenital syphilis increases in the USA. The Lancet Microbe, 3(3), e171. https://doi.org/10.1016/S2666-5247(22)00041-6
2. Alsan, M., Wanamaker, M., Hardeman, R. R., & Kennedy, J. F. (2019). The Tuskegee Study of Untreated Syphilis: A Case Study in Peripheral Trauma with Implications for Health Professionals. https://doi.org/10.1007/s11606-019-05309-8
3. Prenatal Syphilis Screening Laws. (n.d.). Retrieved October 24, 2022, from https://www.cdc.gov/std/treatment/syphilis-screenings.htm
4. Interventions and best practices to address increasing rates of syphilis transmission – The Ontario HIV Treatment Network. (n.d.). Retrieved October 24, 2022, from https://www.ohtn.on.ca/rapid-response-interventions-and-best-practices-to-address-increasing-rates-of-syphilis-transmission/
5. With rising trends of syphilis and congenital syphilis in some countries in the Americas, PAHO calls for reinforcement of public health measures – PAHO/WHO | Pan American Health Organization. (n.d.). Retrieved October 24, 2022, from https://www.paho.org/en/news/5-7-2022-rising-trends-syphilis-and-congenital-syphilis-some-countries-americas-paho-calls
6. Slutsker, J. S., Hennessy, R. R., & Schillinger, J. A. (2010). Morbidity and Mortality Weekly Report. https://www.
7. National Overview. (n.d.). Retrieved October 23, 2022, from https://www.cdc.gov/std/statistics/2020/overview.htm#CongenitalSyphilis