Spike in Valley women with syphilis prompts health concern

State health officials are sounding an alarm about an increase in syphilis cases among women, and the Central Valley and Los Angeles lead the state in women giving birth to babies with the disease, the officials said this week.

The state concern over the sexually transmitted disease came as no surprise to health officials in the central San Joaquin Valley. In March, Dr. Kenneth Bird, Fresno County’s health officer, designated the county as an “area of high syphilis morbidity.” The county will be the site of a statewide meeting in September that will focus on preventing syphilis transmission from mother to newborn.

“The high rates of syphilis in childbearing-age women and newborns is a critical public health matter that will require action from multiple sectors of the community,” Bird said Tuesday. “Accurate information on reproductive health and healthy relationships must be constantly and consistently stressed through our schools, through our families, and through our faith-based organizations. Additionally, health care providers must appropriately screen and treat at every opportunity.”

Four months ago Bird issued a “health alert” in Fresno County about the increase in female syphilis cases. He cited the county’s high rate of congenital syphilis in which the disease is transmitted from an infected mother to a child during pregnancy. Between 2012 and 2014, congenital syphilis cases increased from eight to 33 in Madera, Kings, Tulare, Kern and Fresno counties. Of the 33 cases in 2014, 14 were in Fresno County, Bird said.

In 2013, Fresno County’s incidence rate for congenital syphilis was 7.7 times the state rate and 8.5 times the national rate, Bird said. In 2014, the county’s rate was even higher, and the trend is continuing in 2015, he said.

In his March 13 health alert, Bird told doctors they are required to follow health guidelines: Pregnant women must be screened for syphilis three times during pregnancy — at the initial prenatal visit, early during the third trimester of pregnancy and at delivery.

State health officials don’t know why syphilis cases among women are increasing, said Dr. Juliet Stoltey, an infectious disease physician and public health medical officer at the California Department of Public Health. Women are at increased risk for infection who have multiple sexual partners, have sex with men who have sex with men, and who live in regions with higher rates of syphilis, she said.

From 2012 to 2014, the annual number of early syphilis cases among women more than doubled in California from 248 to 594. And the number of congenital syphilis cases more than tripled in that period from 30 to 100.

California health officials hope to work with county health departments “to reach out to infected pregnant women to make sure they and their partners are tested,” she said. “We know that doctors do screen for syphilis among pregnant women, but many did not receive prenatal care or accessed it late in their pregnancy.”

Kings County recently had a baby born with syphilis, said Dr. Michael Maclean, the county’s health officer. The mother had no prenatal care, he said. The baby is doing fine and the county is managing the case, he said.

The county had two congenital syphilis cases in 2014. Both were stillbirths. Infection during pregnancy can cause stillbirths, infant deaths, deafness and blindness, among other health problems.

Maclean said women have access to prenatal care and he’s not sure why they are not seeking care or fail to seek treatment early in pregnancy. “Any woman who is pregnant and is low-income in California is Medi-Cal eligible, and it is not hard to get signed up,” he said.

Madera County avoided a congenital syphilis case in 2014 by catching the sexually transmitted disease early in the mother’s pregnancy, said Van Do-Reynoso, the county’s health director. “The mom got treated so the child was asymptomatic,” she said.

The county has seen an increase in women who have syphilis, from four cases in 2013 to 20 in 2014, Do-Reynoso said. A change in how Madera County reports the syphilis cases could be behind the increase, she said, and more women may have access to prenatal care through the Affordable Care Act. “But it’s hard to say.”

The statewide health meeting in September is important, Do-Reynoso said. County health officials need to develop strategies “on how do we manage the syphilis incidence as well as other STDs (sexually transmitted diseases),” she said.

Tulare County health officials could not provide numbers Tuesday.

Merced health officials said they have not had a congenital case of syphilis in the past few years, but one case would be too many.

“We’re seeing more and more female cases, and with female cases comes the risk of congenital cases,” said Richard Rios, a public health program manager at the Merced County Department of Public Health. The county had five female cases reported in 2014, and so far this year has had four cases.

It’s unlikely there’s one cause for the increase in syphilis cases, Rios said, but the Valley’s younger population could be a factor. “We have a higher percentage of people who would be coming more sexually active.”

This story was originally published July 13, 2015 at 7:30 PM with the headline "Spike in Valley women with syphilis prompts health concern."