Health CareNews & Opinion

Atrium Doctors Warn of Rapid Rise in Syphilis Cases Locally and Statewide

Cases rapidly rising among young women, bringing risk of congenital syphilis

A person looks on while a doctor collects a syphilis test sample
Syphilis cases have risen more than 600% in North Carolina over 12 years. (AdobeStock)

Atrium Health doctors warned North Carolinians of the significant increase in syphilis cases in a virtual press conference for media members across the state on Wednesday.

While overall syphilis rates have been steadily climbing for 12 years, leading to a 631% increase in cases since 2012, the numbers have more than doubled since 2018, Atrium officials warned. 

The most rapid increase seems to be in women of childbearing age, said Dr. Amina Ahmed, medical director of Pediatric Infectious Disease and Immunology at Atrium Health Levine Children’s Hospital. 

This has led to a rise in congenital syphilis (CS), a disease that develops when a mother with syphilis passes the infection on to her baby during pregnancy. 

“Awareness that this was happening certainly was overshadowed and eclipsed by the COVID pandemic,” Ahmed said. “But this epidemic has been going on much longer than the COVID pandemic.”

Doctors test for syphilis using antibodies, making it difficult to diagnose babies with CS, Ahmed explained. If a mother is not treated in time or adequately, doctors have to evaluate the baby through blood tests or spinal taps and administer long-term IV treatment.

Babies with CS are at risk of stillbirths, premature births and meningitis as well as impacts on bone development, hearing and vision if left untreated.

The symptoms of syphilis, known as the “great masquerader,” can be easily missed and sometimes overlap with other infections, stressing the importance of testing and early diagnosis, regardless of the presence of symptoms.

Dr Rebecca Pierce-Williams, OB-GYN at Atrium Health Women’s Care Maternal Fetal Medicine, said while one of the more common symptoms is a legion on the external genitals called a painless chancre, many women can present as asymptomatic or don’t know they are showing symptoms of syphilis.

A health care professional carries out an instant syphilis and HIV test
Syphilis cases among pregnant women brings with them a risk of congenital syphilis in the child. (AdobeStock)

Although North Carolina requires syphilis testing for pregnant women at 28 weeks and at admission for delivery, the transfer of infection could have already reached the baby earlier in the pregnancy. 

“This is what’s so frustrating about syphilis is it’s so easily treated if we can find it,” said Dr. Michael Leonard, assistant specialty director at Atrium Health Infectious Disease Kenilworth. “And that’s really where the problem lies.”

Treatment for adults includes one to three injections of penicillin, depending on which of the three stages the infection has reached. Babies who have been exposed receive penicillin intravenously for at least 10 days. 

Leonard also mentioned the importance of identifying sexual partners and urging them to get tested.

“If a mom gets treated in pregnancy she can get reinfected,” Pierce-Williams added. “If her partner’s not treated and she gets reinfected then we have to start all over again with treating her.”

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Leonard said future trends are showing a steady increase in syphilis and CS infections, with Mecklenburg County accounting for a large portion of cases in North Carolina. In 2022, North Carolina reported 4,123 cases of early syphilis (infected within the past 12 months) and Mecklenburg county made up 844 of those cases.

Roughly, that means Mecklenburg County residents made up about 20% of the new cases in North Carolina, despite making up just over 10% of the state’s residents as a whole.

The largest demographic represented among the rise in cases over the past 12 years has been men of color who have sex with other men and fall into the 25-34 age range. 

“We have mandates for [pregnant women], we don’t have that in any other population, though,” Leonard said. “So it’s the responsibility of physicians, clinicians, etc. to do the testing … and for patients to report symptoms and seek care.”

Mecklenburg County Public Health offers free HIV/STI testing and treatment at its Billingsley and Beatties Ford clinics in east and west Charlotte, respectively.


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