Arizona leads the nation for its rate of syphilis in newborns. Here's why

Arizona in 2021 led the nation for its rate of syphilis in newborns, and preliminary state data indicates the problem got worse last year.

Arizona's rate of babies born with syphilis in 2021 was nearly three times the national average rate, according to new data on sexually transmitted infections ― STIs ― released this month by the U.S. Centers for Disease Control and Prevention.

While syphilis in newborns is preventable, its prevalence is increasing. Preliminary state data says 187 babies were born with syphilis in Arizona last year, up from 181 in 2021.

Most troubling, syphilis caused the deaths of 14 newborns in 2021 and the death toll rose to 21 last year, the preliminary data shows. That number of deaths for 2022 could end up even higher since the state is still reviewing case reports, said Rebecca Scranton, deputy bureau chief of infectious diseases at the Arizona Department of Health Services.

Even if babies don't die from syphilis, they may still suffer serious health consequences, including bone damage, severe anemia, jaundice, skin rashes, meningitis, blindness and hearing loss.

And they likely will spend the first 10 days of their lives in the hospital to clear the infection, Scranton said. Syphilis can lead to miscarriages, which are not reflected in the congenital syphilis data.

Syphilis is a bacteria that can cross the placenta and infect unborn babies. Cases that are passed onto unborn babies during pregnancy are often referred to as congenital syphilis. The state with the second-highest rate of congenital syphilis behind Arizona in 2021 was New Mexico, followed by Louisiana, Mississippi and Texas.

Maine, New Hampshire and Wyoming did not report any babies born with syphilis in 2021 and because of a network security incident Maryland could not finalize its 2021 case notification data, the CDC says.

'Time to sound the alarm': Surge in babies born with syphilis draws attention to lack of care

Arizona congenital syphilis cases rose more than 900% in 5 years

A total of 2,855 babies were born with syphilis in the U.S. in 2021, up by more than 300% since 2016, the data says.

In Arizona, the number of babies born with syphilis increased even more exponentially, by 965% between 2016 and 2021, state data says. Just 17 babies in Arizona were born with syphilis in 2016.

"It is of great concern. It is something that is occurring across the United States. There are significant racial and ethnic disparities," said Dr. Melanie Taylor, an infectious disease physician with the Maricopa County Department of Public Health in Phoenix. "This is an immediate threat to the health of adults across the county, but particularly to unborn infants among mothers who have syphilis."

The average time between acquiring syphilis and the start of the first symptom is 21 days, according to the CDC, but the range is 10 to 90 days. The first symptom may be difficult to identify as it's often a firm, round, and painless sore known as a chancre that appears at the location where syphilis enters the body.

The chancre lasts three to six weeks and heals regardless of whether a person receives treatment, the CDC says, but the infection will progress to secondary syphilis if the person does not receive treatment.

One of the biggest risk factors for congenital syphilis is not getting prenatal care.

When caught early enough, syphilis can be successfully treated with antibiotics. That's why it's important to get tested, especially during pregnancy. Arizona recommends that pregnant people get tested during the first trimester, the third trimester and when the baby is delivered, Scranton said.

"You can get infected with syphilis at any point before or during pregnancy, and even if you get treatment, you can become reinfected," Scranton said. "You really want to start treatment in pregnancy 30 days prior to delivery to have the best chance of preventing it in the baby."

STDs are on the rise: Will this morning-after-style pill help?

'We can only fight this out-of-control epidemic with new funding'

The CDC data underscores a need for more federal funding of STI prevention, David Harvey, executive director of the National Coalition of STD Directors, said this month when the 2021 numbers were released.

“We can only fight this out-of-control epidemic with new funding and the kind of urgency that reflects the enormity of this crisis," Harvey said.

While the new federal data was bad news for the country as a whole, it was especially bad for Arizona. Not only did Arizona lead the nation for its rate of congenital syphilis, but the state also had higher than average overall rates of syphilis, as well as gonorrhea and chlamydia.

Arizona ranked 10th in the nation for its rate of chlamydia in 2021, 14th for its rate of gonorrhea and seventh in the nation for its rate of primary and secondary syphilis, the CDC data shows.

Beyond IVF: Scientists debate ethics of human reproduction without egg and sperm

One of the biggest problems is finding people who are spreading infections, public health officials say.

"It's definitely a challenge. ... If you miss getting a contact connected to care, you might not know that they passed the infection on to a whole bunch of other people until six months down the line," Scranton said.

Scranton said she expects STI numbers in Arizona will continue going up, at least for the immediate future.

"I don't think it's realistic for cases to go down in the next couple of years," she said. "I think if we're doing our job, we want to be finding cases and getting them connected to care. So we are going to see these cases go up before they truly come down. If they go down in a year, that's probably because we stopped screening people."

Public health experts say there are several possible reasons why Arizona is leading the country for its rate of congenital syphilis.

Here are five theories. Some are intertwined.

There's a high prevalence of syphilis among Arizona adults

The rise in congenital syphilis cases is reflective of a high number of syphilis cases in Arizona as a whole.

"We have a lot more syphilis transmitting in the community. It does make it more likely we'll see it in babies. These upward trends are pretty common across the nation," Scranton said. "In Arizona, we have syphilis in every part of the state."

Some of the theories for a national rise in syphilis cases include declines in consistent condom use over time, a lack of access to health care and the stigma.

The 2021 national data shows STIs continue to disproportionately affect gay and bisexual men and younger people, the CDC says. A disproportionate number of cases were diagnosed among Black and American Indian/Alaska Native people, groups more likely to face social conditions that make it more difficult to stay healthy.

For subscribers: How a 2019 Florida law catalyzed a hospital-building boom

COVID-19 meant less staffing for STI investigations

Some public health resources, including staff time, that normally would have gone to STIs, instead went into managing the COVID-19 pandemic, state and federal health officials say. Investigators who normally work on STIs were helping with contact tracing COVID-19 cases, leaving STI work understaffed.

Also, the health system in Arizona was overwhelmed during the worst of the COVID-19 pandemic, meaning people were less likely to seek medical care for reasons unrelated to COVID-19. With less access to medical care, some people with syphilis may have had their infections longer, providing more opportunities to transmit the infection to sexual partners.

"Syphilis did not slow down during COVID, so being able to come back to some of our routine work and using additional funding to create new positions for folks to help out has been super, super helpful," Scranton said.

Too many pregnant people in Arizona aren't getting prenatal care

Prior to COVID-19, delayed or no prenatal care was an issue with congenital syphilis, but that situation appears to have worsened since the pandemic, state and county health officials say.

"What we see is that women are not even accessing prenatal care," Taylor said. "So our efforts by the health department and all of our obstetrics providers are steadfast. But if a woman never enters prenatal care, then we cannot diagnose and prevent, with treatment, that infant from being born with congenital syphilis."

Sometimes pregnant people who don't get prenatal care are using illicit drugs, which can influence rational decision-making skills, Taylor said.

Use of fentanyl is up and drug users often fear health providers

Among those at risk of contracting syphilis in Maricopa County are people using illicit drugs like fentanyl and methamphetamine, Taylor said. Some individuals with addictions may exchange sex for drugs, which puts them at higher risk for infection.

Evidence indicates that substance use disorder, which is often exacerbated by loneliness, untreated mental illness and unresolved trauma, rose during the pandemic. Deaths from opioid overdoses in Arizona increased by 55% between 2019 and 2021.

Among other things, illicit drug users who become pregnant may be fearful of seeking medical care because they don't want anyone to take away their babies.

"These drugs can influence whether someone is willing to come in for care, particularly pregnant women, whether they are willing to come in for prenatal care and screen for syphilis among other STIs," Taylor said.

Barriers to health care in rural areas are ongoing

People living in rural areas can't always find STI screening or transportation to treatment.

While the numbers are small, the highest rates of new syphilis cases in Arizona in 2020 were in Apache, Navajo and Gila counties, an Arizona Department of Health Services report on sexually transmitted infections says. All three of those counties include rural areas with tribal land.

The Navajo Nation's Department of Health on March 31 put out a public health advisory about an increase in syphilis cases and recommended everyone between the ages of 13 and 64 do annual STI testing that includes syphilis. The Navajo Nation covers parts of New Mexico, Utah and northeastern Arizona.

Indian Health Service facilities are often the only option for Indigenous people living in tribal areas and the IHS has long been criticized as underfunded and understaffed.

Scranton said some county, tribal and clinical health programs across the state are tackling the access problems by bringing screening and treatment directly to people's homes.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.