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According to an analysis of hospital billing data shared by Dr. Thomas Dobbs, the medical director for the Mississippi State Department of Health’s Crossroads Clinic in Jackson, which focuses on sexually transmitted infections, the number of babies in Mississippi being treated for congenital syphilis has jumped by more than 900% over five years, uprooting the progress the nation’s poorest state had made in nearly quashing what experts say is an avoidable public health crisis. In 2021, 102 newborns in Mississippi were treated for the sexually transmitted disease, up from 10 in 2016.
Dobbs, the state’s former health officer, said he’s spoken with health care providers who “are absolutely horrified” that babies are being born with the disease, and in rare instances dying from it. “This seems like something that should have happened a hundred years ago, not last year,” said Dobbs, who is also dean of the John D. Bower School of Population Health at the University of Mississippi Medical Center. “There’s really kind of a shock.”
The rise in cases has placed newborns at further risk of life-threatening harm in a state that’s already home to the nation’s worst infant mortality rate. Congenital syphilis occurs when the infection is passed from a mother to her child while she’s pregnant. If untreated, a pregnant woman with syphilis has an 80% chance of passing it to her baby.
Babies infected with syphilis may not initially show symptoms, but for those who are not treated within three months of birth, complications can be severe. Syphilis can damage a baby’s organs. The disease can pummel a child’s nervous system and imperil their vision and hearing. In the gravest cases, newborns die.
The Mississippi State Department of Health does not formally track congenital syphilis deaths but said there was at least one baby who died in 2021. The resurgence also shows how the state’s racial disparities can be present from the first day of life. In 2020, Black newborns accounted for 70% of the state’s congenital syphilis cases, despite making up about 42% of the state’s live births that year.
For a growing number of Mississippi moms and their children, treatment is not happening in time. Some counties in the state lack an obstetrician, which means pregnant residents must travel for care. Depending on their job, time away from work means lost income, while unreliable transportation might cause a patient to miss appointments. And many pregnant Mississippians have to wait weeks before their first prenatal visit; last year, it took about a month on average for applicants to be approved for a public health insurance program through Medicaid that covers most pregnancies in the state.
Dr. Anita Henderson, a Hattiesburg-based pediatrician, said in the past three to four years she’s treated more babies with congenital syphilis than she had in nearly all of her 25-year career. “I don’t think many people know there is the potential for babies to die from congenital syphilis,” she said.
Henderson is concerned that the state’s public health infrastructure has weakened. In 2016, the Department of Health announced it was closing nine county health departments. Last year, the Mississippi Delta — which has some of the nation’s highest poverty rates and has long faced lean access to vital maternal and infant health care services — saw its last remaining neonatal intensive care unit close, while another provider, Greenwood Leflore Hospital, shuttered its labor and delivery ward.
“In a rural state like Mississippi, we’re going to have to look at where are the pockets of disease and how can we reach
those populations,” Henderson said. “If we don’t have an infrastructure in place, then it’s not going to matter if we have a cure.”
The rise in cases of congenital syphilis in Mississippi is not unique to the state, however. The U.S. Centers for Disease Control and Prevention reported a 44% increase in the number of congenital syphilis cases nationwide from 2015 to 2019. That increase has been attributed to a number of factors, including cuts to public health funding, a lack of access to health care and testing, and the stigma that still surrounds sexually transmitted infections.
But even as other states work to address the problem, Mississippi’s lack of access to health care and high poverty rates have made it particularly vulnerable. Experts say that to address the issue, the state needs to invest in its public health infrastructure and increase access to care.
“Mississippi needs to focus on prevention,” said Dr. Beverly Woolf, the medical director of the Crossroads Clinic. “We need to get people tested, and we need to get them treated. And we need to make sure that everyone has access to care.”
Woolf said that in addition to expanding access to health care, the state needs to do more to educate the public about sexually transmitted infections and how to prevent them. She also emphasized the importance of getting pregnant women tested for syphilis early in their pregnancies.
“We need to make sure that women get tested as soon as they find out they’re pregnant,” Woolf said. “And if they test positive, we need to get them treated right away.”
Without concerted efforts to address the problem, Mississippi’s rates of congenital syphilis are likely to continue to rise, putting even more newborns at risk. But experts say that with the right investments in public health and access to care, the state can turn the tide on this preventable and deadly disease.