DENVER — Colorado is ramping up its response to combat a growing syphilis epidemic following an "alarming increase" in cases among newborns over the past several years.
Gov. Jared Polis made the announcement Thursday along with nearly a dozen other state officials at the Governor’s Mansion, calling the yearslong trend a “real danger” for Colorado newborns.
“This disease is easily treated, but it can be very harmful and deadly for babies and that's what we're sadly seeing across our state,” Polis said, adding he hoped the state could reverse the trend through more accessible testing, especially among people who don’t have access to routine, prenatal care, such as people who are incarcerated or those who are unhoused.
The number of people with syphilis has skyrocketed to levels not seen since the 1950s, with cases increasing by 80% between 2018 and 2022, according to the U.S. Centers for Disease Control and Prevention (CDC).
In Colorado, cases have more than tripled, from 1,084 in 2018 to 3,266 in 2023, said state epidemiologist Dr. Rachel Herlihy, but more worrisome were the number of cases among babies, which increased seven-fold across the state within that same time frame.
Among the 3,000 cases reported last year, 50 were among newborns. Since the beginning of this year, she said, “we have already seen 25 cases of congenital syphilis, including five stillbirths and two neonatal deaths.”
That increase will put Colorado “on track to perhaps have more than 100 cases by the end of the year,” Herlihy added.
To combat the epidemic, the Colorado Department of Public Health and Environment (CDPHE) is launching what executive director Jill Hunsaker Ryan called an “all-out infection control effort” to reduce syphilis more broadly among the general public, but especially among pregnant people.
“Finding cases and getting people treated early in the disease process is our goal,” Ryan said as she announced she was issuing a public health order “which will give women the opportunity to be tested and treated to prevent our youngest residents from experiencing the long-term consequences of an in utero syphilis infection, or worse, stillborn or newborn death.”
Starting April 25, healthcare providers across the state will be required to provide syphilis testing to pregnant people, with testing offered at the first prenatal visit, early in the third trimester and at the time of delivery, Ryan said.
“There’s also required testing if someone who was pregnant goes to an urgent care center or an emergency room without having had prenatal care, or in the event of a miscarriage after 20 weeks’ gestation or stillbirth,” Ryan explained, adding that this will apply to all healthcare settings and providers who care for anyone who is pregnant, including those in jails and prisons.
Pregnant people who are offered the test do not have to take it, Ryan said.
Additional recommendations will include offering one-time screening for all sexually active Coloradans ages 15-44 and offering annual syphilis testing for sexually active men who have sex with men (MSM), transgender residents, Coloradans who identify outside the gender binary and people living with HIV.
The “all-hands-on-deck” approach will not only involve the state health department and the Department of Corrections, but will also include the Department of Public Safety, the Department of Human Services, and the Department of Local Affairs, officials said.
The state health department has already been working on a pilot program with the Pueblo County Jail since 2021 to bring testing and treatment to anyone who is pregnant in a county jail setting, said Pueblo County Sheriff David Lucero during Thursday’s news conference.
Of the 634 incarcerated people who were screened for syphilis since the pilot program began, 182, or 26.7%, were positive for the disease, Lucero said. Of the 634 people screened, 27 were pregnant and 7 of those were positive for syphilis.
“Without our program, these patients who had received no pre-natal care would never have been tested and connected to the treatment,” Lucero said. “Without access to the testing, these patients likely would not have been diagnosed with syphilis at delivery, and their babies would have been born with congenital syphilis. Without a doubt, this program saved lives.”
The sheriff said that because of the success of the program in Pueblo, El Paso and Jefferson counties also now had similar screening programs in place.
WHAT IS SYPHILIS AND HOW DOES IT AFFECT BABIES?
Syphilis is a sexually transmitted infection (STI) that develops in stages and transmits by direct contact with a syphilis sore during vaginal, anal or oral sex, according to a fact sheet from the CDC. It does not spread through casual contact with objects such as doorknobs, toilet seats, swimming pools, hot tubs, bathtubs or by sharing clothing or eating utensils.
There are four stages of syphilis (primary, secondary, latent, and tertiary), with each stage displaying different signs and symptoms.
The primary stage will present with single or multiple firm, round and painless sores where syphilis entered a person's body that usually last three to six weeks before healing, regardless of whether some receives treatment. The secondary stage of the disease will then begin, where people may develop skin rashes and/or sores that are rough, red or reddish-brown in the mouth, vagina, or anus. The rash can be on the palms of the hands and/or the bottoms of the feet and usually won’t itch, according to the CDC.
Fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue are some of the other symptoms that could signal a syphilis infection before entering the latent stage of syphilis, when there are no visible signs or symptoms of the disease.
It's important to note that people who contract syphilis don’t always show signs or symptoms that they have the disease, meaning someone who is infected with syphilis can spread the infection to someone else without knowing it, Herlihy said.
If untreated, syphilis can turn serious or even deadly at the tertiary stage.
“It can result in a variety of complications to the heart, to blood vessels, to the brain. It can cause seizures, it can cause meningitis-type symptoms, it can cause dementia, it can cause hearing loss, it can cause blindness,” said Herlihy.
When passed on to the baby during pregnancy — known as congenital syphilis — it can cause miscarriage, stillbirth, prematurity, low birth weight, along with several birth defects and permanent disabilities (including blindness, deafness, developmental delays, or bone abnormalities) and ultimately, infant death, according to the CDC.
“Congenital syphilis occurs in about 70% to 100% of babies that are born to someone who isn't treated during their pregnancy, but only in 1% to 2% of babies who are born to a parent who received treatment,” Herlihy said.
Per the CDC, approximately 40% of babies with untreated congenital syphilis may be stillborn or die from an infection.
Luckily, highly effective antibiotic treatments exist for syphilis, such as penicillin, Herlihy said.
“We just need to get people to take it soon enough to save infants’ lives and prevent long-term complications," she said.
People can reduce their risk of contracting syphilis by being in a long-term monogamous relationship with a partner who has been tested and does not have syphilis, and by using condoms properly, according to the CDC.
In 2022, more than 3,700 babies were born with congenital syphilis in the U.S., a 937% increase from the previous decade, the CDC states. The disease was nearly eradicated in the 1990s in the U.S., but came roaring back amid stagnant funding for sexually transmitted diseases.
“Syphilis was once a rare disease. We are very concerned about this growing epidemic, both in the state and nationally. It is devastating for babies, but there is an effective treatment if caught in utero,” said Ryan.
Polis said he hoped the “comprehensive response will help turn the corner and hopefully start setting the trends the other way.”
