AZ second worst rate in US for congenital syphilis

WASHINGTON, DC – Cases of congenital syphilis in Arizona increased more than sevenfold from 2016 to 2020, moving the state from sixth to second worst in the nation at that time, according to the Centers for Disease Control and Prevention.

And while the increase in Arizona leveled off slightly between 2019 and 2020, experts aren’t sure if that was because there were fewer cases or just fewer cases detected as COVID-19 made testing less. accessible.

“There’s been a change in access to care, whether it’s your primary care doctor just doing…telemedicine or you can’t get emergency care because there’s a lot of COVID” said Matthew Christenberry of the Pima County Health Department. .

Christenberry, project manager for the county’s Epidemiological Intelligence Unit, said he is currently reviewing the county’s 2020 congenital syphilis data to see if there are fewer tests being done or if the positivity rate has gone down. this year.

The CDC report showed that congenital syphilis — a sexually transmitted disease that an infected pregnant woman passes on to her fetus — rose from 20.1 cases per 100,000 live births in 2016 to 151.2 cases in 2020. next was New Mexico, which had a rate of 182.9 cases per 100,000 live births in 2020.

Arizona’s increase far outpaced the increase in congenital syphilis cases nationwide, which increased about 3.5 times from 16.1 cases per 100,000 live births in 2016 to 57 ,3 in 2020.

This was true for STDs in general. While Arizona and the United States have seen an increase in cases of syphilis and gonorrhea, Arizona’s rates for both diseases have been rising faster and faster. Only chlamydia fell between 2019 and 2020. Although Arizona fell slightly faster than the United States, its chlamydia rate of 512.3 cases per 100,000 population was well above the national rate of 481.3.

In raw numbers, congenital syphilis had the fewest infections, measuring in the tens in Arizona compared to the thousands of cases of gonorrhea and tens of thousands of chlamydia. But compared to other states, congenital syphilis is a much bigger concern in Arizona.

The state ranked 15th in rates of gonorrhea and chlamydia in 2020, and sixth in rates of primary and secondary syphilis, which refers to the first two stages of the disease.

Christenberry said part of the problem could be the lack of access to prenatal care in the early days of the pandemic.

“What we think we’re seeing are missed opportunities,” he said. “We just need to better understand how to get these people into antenatal care so that we can complete the tests and if someone is positive during pregnancy then we can treat them appropriately.”

But health experts like Christenberry noted that vulnerable communities were at particular risk even before the pandemic.

Dr. Leandro Mena, director of the CDC’s STD prevention division, said pregnant women who struggle with substance abuse and poverty are less likely to be able to get tested, due to issues such as lack of insurance. disease and the stigma of STDs in their lives. community.

Christenberry echoed Mena and added homelessness and incarceration during pregnancy as other significant risk factors for not having access to testing and treatment for STDs, especially syphilis.

Arizona requires testing for congenital syphilis at three points in pregnancy, but Christenberry said the requirement can only be met if pregnant women can access providers. During the pandemic, people may have been “afraid to access the care” they needed, he said.

“People may not know when to get tested,” he said. “But also any time a pregnant woman is out and visits an urgent care unit or visits her primary care doctor, but she doesn’t go to her obstetrician/gynecologist for pregnancy…tests may not take place, as there could be an assumption that they are getting tested.

According to Mena, the key to monitoring congenital syphilis rates is tracking primary and secondary syphilis in women of childbearing age before they can pass it on to their child.

“It would ultimately prevent … the newborn from having syphilis or having worse outcomes,” Christenberry said.

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