Congenital Syphilis in Texas Section 1 - Executive Summary

Syphilis is caused by the bacterium Treponema pallidum. Congenital syphilis (CS) occurs when a pregnant woman passes syphilis to her baby during pregnancy. [1] CS may lead to miscarriage, stillbirth, premature birth, and death immediately after birth. Death occurs in up to 40 percent of infants born to women with untreated syphilis because of the infection. [1] While congenital syphilis can occur without symptoms, it can also present with a spectrum of serious manifestations, including but not limited to, vision or hearing loss and improper bone or tooth development. These outcomes can be avoided with early detection and proper treatment during pregnancy. Only Benzathine Penicillin G can be used to treat syphilis during pregnancy and adequate treatment can prevent CS with a success rate of 98 percent. [2]

In the U.S., the number of CS cases has increased each year since 2012. [2,3]  In 2018, 1,306 cases were reported nationally, which included 78 stillbirths and 16 deaths. [3] Of these nationally reported cases, Texas accounted for approximately one-quarter (367 cases), ranking Texas first in the nation in 2018. The bulk of CS in Texas is in the three most populous metropolitan areas: Harris County (28 percent), Bexar County (17 percent), and Dallas County (16 percent), as well as the Rio Grande Valley (12 percent)

CS cases rise when syphilis cases in women of childbearing age (aged 15-44 years) rise. Texas CS cases have risen by an alarming 365 percent since 2012 when a total of 79 cases were reported. Nearly nine out of 10 of the infants reported with CS were delivered by Hispanic (45 percent) and Black (44 percent) women. Primary and secondary (P&S) syphilis among women of childbearing age rose in Texas from 2012 through 2018 (250 cases of P&S in 2012 to 380 cases in 2018). In 2018, about one-third (30 percent) of the mothers had a late diagnosis (less than 45 days prior to delivery). Additionally, among women delivering an infant with CS, 64 percent had inadequate treatment and 8 percent had no treatment. The rise in CS cases may be attributed to barriers to care that these women experience, such as transportation issues, finding a provider, or access to Medicaid.

The Texas Department of State Health Services (DSHS) is developing a logic model and corresponding workplan to determine steps that DSHS can take to decrease the number of CS cases in Texas. Some of these include ensuring adequate treatment for pregnant women diagnosed with syphilis by improving testing, treatment, and reporting as well as increasing education for providers and the public. Additionally, DSHS aims to decrease barriers to care for pregnant women.

Note 1. Centers for Disease Control and Prevention (CDC). Congenital Syphilis-Fact Sheet; Dated January 31, 2017.

Note 2. Bowen, V., Su, J., Torrone, E., Kidd, S., & Weinstock, H. (2015). Increase in Incidence of Congenital Syphilis – United States, 2012–2014. Morbidity and Mortality Weekly Report,64(44), 1241-1245.

Note 3. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance 2018.; October 2019. (PDF)

Congenital Syphilis in Texas

Table of Contents | Executive Summary | About this Report | Understanding Syphilis | An Overview of Congenital Syphilis and Syphilis in Women of Childbearing Age in Texas | Maternal Demographics for Women Delivering Infants with Congenital Syphilis | Barriers to Care | Birth Outcomes Associated with Congenital Syphilis | Congenital Syphilis Cascade