New state law requires additional test during pregnancy
October 4, 2019 - Texas public health officials are reminding health care professionals about a new law increasing syphilis testing during pregnancy. Texas law now mandates three syphilis tests: at the first prenatal exam, during the third trimester, and at delivery. The new requirement took effect last month and comes as the state has seen a sharp increase in the number of syphilis infections passed from mother to child.
Congenital syphilis cases reported to the Texas Department of State Health Services more than doubled last year amid an ongoing increase in syphilis among women of childbearing age and an enhanced public health effort to detect and track cases. There were 367 cases of congenital syphilis in Texas in 2018, up from 164 in 2017. In addition to laboratory confirmed cases, the total includes all babies born to women with a history of syphilis and no documented treatment.
“Congenital syphilis can have devastating effects on a child, but it is preventable when treatment begins in time,” said Dr. John Hellerstedt, DSHS commissioner. “Testing in accordance with the new law will provide the best opportunity to treat the infection so the infant doesn’t suffer permanent consequences.”
Health care providers are encouraged to document syphilis treatment completely and report that treatment to their local health department so that babies of mothers who received treatment won’t mistakenly be counted as cases.
DSHS has taken a number of steps to detect and reduce congenital syphilis cases in Texas, including:
- Issuing today’s health advisory with testing and treatment guidance for health professionals.
- Hiring a congenital syphilis epidemiologist and congenital syphilis coordinator to lead efforts to better understand the causes of maternal and fetal infections in Texas.
- Encouraging the creation of community-based teams that review congenital syphilis cases to identify systemic barriers to care and ways to reduce those barriers. Review teams are operating in Houston and San Antonio with plans to expand to Dallas and the Rio Grande Valley.
- Working with other jurisdictions reporting at least 10 cases per year to begin internal case reviews.
- Using birth records to find cases that may have been missed before or at delivery so public health can verify treatment or work with doctors to evaluate and test the infant.
- Following up on pregnant women with a previous syphilis infection who don’t have a record of receiving adequate treatment.
The increase in reported cases is likely due to a combination of a higher incidence of disease among women and increased public health surveillance. A lack of or delayed prenatal care remains a significant factor in the growing number of congenital syphilis cases, and health officials encourage women to seek prenatal care as early in their pregnancy as possible.