Dr. Sundari Mase, the county’s health officer, said syphilis can be best treated through early detection, and anyone who is at risk of infection should be screened and tested. In the case of women who are pregnant, it’s especially important to establish strong prenatal care and to do all the screen tests that are required.
“The people who are falling through the cracks are those who don’t have prenatal care,” Mase said. “That’s who we need to be reaching out to.”
Current screening requirements for pregnant women call for syphilis testing during the first trimester, again during the third trimester and also during delivery. The battery of tests throughout the pregnancy ensures that a syphilis infection is not missed.
“If it’s a high-risk OB setting, we definitely want people to be tested three times because they can be sexually active up until the day they deliver,” said Alan Powell, a public health investigator with the county Department of Health Services.
Powell, who is among the county’s staff that does outreach to those at high risk of contracting syphilis, said that throughout the state congenital syphilis has primarily seen among those who use methamphetamine, but also fentanyl and heroin. They’re often homeless or lack prenatal care, he said.
“We have those same risk factors here in Sonoma County, so our goal is to do outreach and education in that population,” he said.
Powell said county health services staff link up with local health care providers like Providence and Santa Rosa Community Health to “wrap our arms” around anyone at high risk of contracting syphilis and may not follow through with their prenatal care schedule.
“Often it’s not just getting somebody diagnosed, but also helping them stay motivated to continue with their prenatal appointments all the way to the very end,” Powell said.
People who are homeless often find it difficult to go to the a clinic or doctor’s office, he said. “We, in essence, bring the clinic to the street … by going into the homeless camps and doing rapid syphilis test, rapid HIV tests.”
The California Department of Public Health has in recent years called on local public health agencies to ramp up testing of both HIV and syphilis among high-risk groups to address alarming increases in both congenital syphilis and perinatal HIV.
Last November, the state public health agency issued screening and testing guidance that recommended opt-out HIV and syphilis testing for all pregnant patients receiving services at emergency departments; urgent care clinics; springs; mental health, drug treatment, and syringe services programs; and street medicine or homeless outreach programs.
The guidance also called for screening pregnant patients for HIV at least once and for syphilis three times during pregnancy. The state pointed out that significant racial disparities have been observed, with rates of congenital syphilis among black and Native American infants significantly higher than that of the state overall.
Lund stressed the importance of early diagnosis during pregnancy.
“What’s essential is having people get into prenatal care as early as possible and getting those labs done as early as possible, so that we can identify early and treat early and the bacteria doesn’t have a chance to cross the placenta and affect the baby ,” she said.
Lund said the number of syphilis cases among pregnant patients has steadily grown in recent years.
In 2019, 446 cases of congenital syphilis were reported in the state, the highest number of cases since 1993. The following year, there were six perinatal HIV transmissions in California, compared with four the previous year and three in 2018.
“We have encountered five to 10 pregnant patients a year in our practice at Santa Rosa Community Health as opposed to none in my practice 15 years ago,” Lund said. “Of those prenatal cases, most of them get treated early enough that we prevent transmission to the baby.”
But she said every year, her practice sees patients get diagnosed late in their pregnancy, which requires the baby to be treated with antibiotics for 10 days in the neonatal intensive care unit for presumed congenital syphilis.
“As far as I’m aware none of these babies have had physical effects of these infections but it is a concerning trend,” she said.
In contrast, at Kaiser Permanente Santa Rosa Medical Center, a fully integrated health care system with a smaller share of the county’s indigent patients, has not seen significant increases in the number of cases of prenatal syphilis.
Dr. Kristin Steuerle, a pediatric hospitalist at Kaiser Santa Rosa and chief of the inpatient pediatrics department, said Kaiser also has a robust testing and screening requirement.
“We’ve been very fortunate, mostly because people do have good prenatal care, and come to their appointments … because of that we actually are not seeing an increase in cases within our system and not really a significant increase during the pregnancy,” said Steuerle, who is also medical director of Kaiser’s regional newborn program.
You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.
