Congenital Syphilis Cases Rising; North Carolina on Alert

North Carolina is on alert after five stillbirth and neonatal deaths this year related to congenital syphilis. State law requires clinicians to screen all pregnant women for syphilis at least three times during pregnancy to help prevent congenital syphilis.

North Carolina is on alert due to a notable increase in cases of congenital syphilis.

If untreated during pregnancy, syphilis can lead to miscarriages, stillbirths and neonatal deaths. Five such stillbirths/neonatal deaths occurred between Jan. 1 and Sept. 1, 2023, prompting a public health alert. The North Carolina Department of Health and Human Services issued the alert in November 2023.

In North Carolina, there were five times more syphilis cases in women in 2022 than in 2012. Congenital syphilis infections also increased, from one case in 2012 to 57 cases in 2022. This aligns with a similar trend observed nationwide. 

Babies born with congenital syphilis can face adverse life-long health impacts, including:

  • Intellectual disability
  • Bone and teeth deformities
  • Severe anemia
  • Enlarged liver and spleen
  • Jaundice
  • Nerve problems causing blindness or deafness
  • Meningitis 

Screenings Prevent Congenital Syphilis

Congenital syphilis is preventable. North Carolina public health experts review the state’s cases to identify missed opportunities for prevention. A review of 2022 cases found these missed opportunities: 

  • 53% of women with babies with congenital syphilis had no prenatal care.
  • Of the 47% of women who received prenatal care, more than a third began prenatal care late, in their second or third trimesters. The late start indicates they were not tested three times during pregnancy, as required by North Carolina’s Public Health law.
  • Some women were tested but had inadequate or delayed treatment.

North Carolina law requires clinicians to screen all pregnant women for syphilis at least three times during pregnancy. This is regardless of whether the person is believed to be at higher risk or has symptoms. In 2022, 86% of pregnant women diagnosed with syphilis in North Carolina had no symptoms at the time of diagnosis.

Most mothers of infants with congenital syphilis had incomplete or no prenatal care. Screening can and should occur in a variety of settings. This includes urgent care and emergency room visits.

NCDHHS has several ongoing efforts to increase access to screenings and decrease cases.

Congenital Syphilis Resources for Providers

If you are pregnant or plan to become pregnant, get more information about congenital syphilis.


Related Press Releases

12/15/23: North Carolina Joins Southeastern States in Partnership to Combat the Surge in Congenital Syphilis Infections

12/15/23: NC Medicaid and Public Health Joint Statement on Congenital Syphilis

11/13/23: Five Stillbirth and Neonatal Deaths This Year Related to Congenital Syphilis

4/12/23: This week is Sexually Transmitted Infection Awareness Week — Syphilis Cases on the Rise in North Carolina, Especially in Women and Babies

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