With only a single case in our state about a decade ago, congenital syphilis has been on the rise ever since.
In 2023, (according to preliminary data), North Carolina lost nine people from this completely preventable cause; with another 63 babies suffering from congenital syphilis infection.
According to Victoria Mobley, HIV/STI medical director for the North Carolina Department of Health and Human Services' Division of Public Health, more than half of the mothers of the babies born with syphilis had no documented prenatal care at the time they delivered. Equally of concern, of the women who did have prenatal care, only 41% received appropriate screening tests, despite state law requirements for syphilis testing for anyone who is pregnant (at first pre-natal visit, again between 28-30 weeks gestation and at time of delivery).
Sadly, this is a national epidemic, and more action must be taken to begin to address it.
What can you do?
One of the first steps advocated by NCDHHS and others, is incorporating a comprehensive, patient-centered Sexual Health History. An approach advocated by the American Academy of Family Practice (AAFP) and CDC is to use the '5 Ps' Model.
What are the Five 'P's?
- Protection from STI's
- Past History of STI's
- Pregnancy Intention
See Table 3 on this webpage for suggested questions for each of the 5 topics.
Assure your patients that these are questions that you ask of all patients, regardless of age, gender, or marital status, and are just as important as the questions about other aspects of physical or mental health.
Establish and maintain a safe space for this confidential aspect of history-taking.
There are many opportunities for improvement.
These range from addressing deficiencies in pre-natal care access and utilization, adherence to evidence-based practice guidelines (and state law requirements for testing), access to benzathine penicillin, and stigma around discussing sex.
We cannot lose any more people to this preventable condition. Begin today to reverse this terrible trend.
Graph adapted from: NCDHHS https://www.dph.ncdhhs.gov/epidemiology/communicable-disease/syphilis/congenital-syphilis-provider-resources