LA County sees number of babies with syphilis on the rise

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The woman said she was consumed with pain and disbelief on the hospital bed, her stomach covered in ultrasound gel, when a hospital employee broke the news: there was a baby in she.

It was a boy. Six months along.

And his heart was not beating.

For months, the 30-year-old had been shaking her swollen stomach and ankles. Pregnancy seemed impossible because she had had difficulty conceiving in the past.

Plus, she said, “you put all bad thoughts on the back burner when you’re high.”

It wasn’t until a few days later, as she was crying for her unexpected baby at home in Los Angeles County, that a nurse called her to tell her what had happened, she said. she declared. She calls it “the S”, a disease she is always embarrassed to name.

More and more babies in LA County have been infected with syphilis in the womb, which can cause stillbirth, neurological problems, blindness, bone abnormalities and other complications. Nine years ago, only six cases were reported in LA County, according to a report from the Department of Public Health. Last year, that number reached 113.

Numbers were already rising before COVID-19 arrived, but public health officials fear the pandemic will exacerbate the problem, closing clinics that screen for syphilis and other sexually transmitted infections and putting new ones efforts to control disease on the ice.

The woman whose baby was stillborn, who spoke on condition of anonymity to protect her privacy, said she gave birth in a hotel room in January. She had avoided receiving medical attention despite painful wounds.

At the time, she said, she was concerned that going to a clinic would lead to her being jailed for using methamphetamine. “You think, ‘I’m going to be in trouble because I’m high,'” she said.

The congenital syphilis outbreak has been particularly frustrating for experts, as the disease can be thwarted if pregnant women are tested and treated on time. Other countries have been credited with having stopped mother-to-child transmission of syphilis in recent years, including Thailand and Belarus.

Federal officials once thought the United States was about to join them. Instead, cases of congenital syphilis have skyrocketed nationwide, from 334 cases in 2012 to more than 2,000 in 2020.

“There hasn’t been a sustained investment for the number of years it has taken to truly eliminate syphilis,” said Mario Pérez, director of the HIV and STD programs division of the public health department of the United States. LA County.

Experts have linked the wider rise in syphilis to a web of factors, including methamphetamine use and sex without a condom. Men who have sex with men have been particularly vulnerable, but the growing number of women and babies has particularly alarmed health officials because of the potentially devastating consequences.

Syphilis is curable in an infant if detected and treated in time, but if a mother is also HIV-positive, a syphilis infection can increase the risk of transmitting HIV to the baby by breaking the natural barrier of the placenta, the placenta said. Dr. Mikhaela Cielo, pediatric infectious disease physician at LA County-USC Medical Center.

The disease behaved like a sort of sinister prism, refracting societal issues such as drug addiction and homelessness. In Los Angeles County, up to two-thirds of mothers who passed syphilis to their babies reported using drugs during their pregnancy, according to Department of Public Health studies of cases between 2016 and 2018.

Between 10 and 20% were not accommodated. Forty percent have never had antenatal care. And nearly 30% had a history of arrest or incarceration. In LA County prisons, eight cases of syphilis had been confirmed among 170 pregnant patients seen in late August, said Dr Noah Nattell. who oversees women’s health for the county correctional health services agency.

The LA County Department of Public Health mobile clinic, in partnership with People Concern and Los Angeles Christian Health Centers, tests people for syphilis, hepatitis C and HIV and also provides hot meals and other basic necessities.

(Mel Melcon / Los Angeles Times)

Syphilis is hardly confined to prisons, but “all the systems in place that lead to someone being incarcerated,” he said, “are also those that lead people to avoid or be excluded from the medical system. “.

The disease also reflects racial inequality: The vast majority of syphilis cases reported among LA County women of childbearing age have been in Latin and black women, according to county statistics.

Woman who lost her baby said she started using methamphetamine at a crucial time in her life, faced with the demands of stressful work, school and a strained relationship after her previous struggle to get pregnant.

At the time, drugs looked like “a ticket to freedom”. She quit her thankless job. Her boyfriend has moved. The meth made her feel brave, “like I could finally take a deep breath.”

She started seeing a man who told her he didn’t need to use a condom with her, a decision she now considers naive. After their breakup, she formed a relationship with a friend who would become the father of her baby.

When waves of pain began to wash over her in a hotel room where she was spending time with her boyfriend, another man, and her girlfriend, the girlfriend quickly realized she was in labor. and urged them to call 911, she said. But the men bristled at the idea, she recalls, because there were drugs there and they didn’t want police attention.

Jennifer Wagman, associate professor of community health sciences at UCLA’s Fielding School of Public Health, said the growing number of congenital syphilis across the country is a sign of missed opportunities to stop the disease. Researchers have found that nationwide, not all pregnant women are screened for syphilis despite urging from health officials.

Even when diagnosed, nearly a third of pregnant women with syphilis did not receive the care they needed, according to an analysis by the U.S. Centers for Disease Control and Prevention. Wagman said there are many reasons related to other issues in their life: some are uninsured. Some may have been tested but never got results or treatment because they don’t have a regular address or phone number.

And some fear that if they see a doctor and are found to be using drugs, they may be forced to abandon their child. The LA County report found that between 2016 and 2018, at least 30% of babies with congenital syphilis were placed in the care of the Department of Children and Family Services.

County officials said doctors can report concerns about children’s safety to DCFS, but it is “only in the most extreme cases” that an infant would be removed, following an assessment that takes place after birth and not during antenatal care.

The LA County woman also feared, after her baby died, that she could face criminal charges because methamphetamine was in her pregnant body – leading to charges for other women in California. At one point, the morgue told her she had to put the cremation on hold because “the state got involved,” but no charges followed, she said.

Some experts see the resurgence of the disease as a symptom of poor sexual health. Jeffrey Klausner, clinical professor of population and public health sciences at USC’s Keck School of Medicine, said federal funding fell about 15 years ago, followed by cuts for public health agencies due to the recession that followed.

In a county as large as Los Angeles, he argued, there must be a proactive strategy to tackle sexually transmitted diseases that are reaching affected communities. Instead, “everything has been very piecemeal, responsive and disjointed.”

The pandemic did not help. A state investigation found that in the majority of health jurisdictions that responded, more than half of the workforce had been reassigned to COVID-19 duties last September.

Reported cases of syphilis have fallen across California, but officials warn it could be due to less testing. Many clinics where the LA County Public Health Department provides screening, diagnosis and treatment for STDs have been temporarily closed amid the pandemic.

Plans to launch a new team focused on “rapid response” to syphilis cases – including offering testing to people in homeless settlements – have been derailed. Nurses who usually handle cases of women diagnosed with syphilis have been called in to perform coronavirus-related duties, meaning others have had to take on the task, handling 30 to 40 cases each in addition to their other responsibilities, said Dr Sonali Kulkarni, medical director of the county division of HIV and STD programs.

In August, the Los Angeles County Commission on HIV warned that “an already understaffed and underfunded STD response has been made worse by the redeployment of nearly all staff to COVID-19 work.” Most of the county and community programs have been “severely reduced in capacity or suspended entirely.”

Ciara DeVozza chats with Janice Johnson as she waits for test results at a mobile clinic in downtown Los Angeles.

Ciara DeVozza, left, program director at People Concern, and Janice Johnson chat while awaiting test results from the mobile clinic. To reach marginalized people, ”DeVozza says,“ you have to be here looking for them, making them feel safe. ”

(Mel Melcon / Los Angeles Times)

A rare exception is a mobile skid clinic, launched during the pandemic by Los Angeles Christian Health Centers, People Concern, and the county public health department, to test people for sexually transmitted infections.

Since her rapid test detects any exposure to syphilis, including past infections, more blood should be drawn to check for the current infection. It can take days to get these results, which can mean finding patients on the street. The skid row effort also dispenses hot meals, hygiene kits, naloxone spray to reverse overdoses, and other necessities.

To reach marginalized people, “you have to be here looking for them, making them feel safe,” said Ciara DeVozza, director of the C3 Homelessness Team on Skid Row for People Concern. “This is not how the medical system is designed.”

When her baby was cremated, the LA County woman asked to put her ashes in an urn decorated with an angel wrapping her wings on an infant.

“I’ve always wanted a baby,” she says. “I have always asked this of God and now I have received this gift – and I must decide how to put this gift to rest.”

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