Media release: Rise in congenital syphilis requires action – experts

There is a global resurgence of syphilis that is having inequitable impacts amongst Māori and Pacific whānau and for pregnant women and babies in Aotearoa. Experts in congenital syphilis say repeat screening for syphilis in the third trimester of pregnancy could help.

Congenital syphilis occurs when a mother with syphilis passes the infection on to her baby during pregnancy. Prior to 2017 cases in NZ were rare but in the last five years there have been more than 25 infections. “The consequences of syphilis in pregnancy include fetal death, prematurity, and critically ill newborns,” says Dr Emma Best, a Paediatric Infectious Diseases specialist with the University of Auckland.

Dr Best and other authors write about the increasing congenital syphilis cases in NZ in the latest Briefing from the Public Health Communication Centre. They say it is a disease we should never see as we have the tools to eliminate syphilis.

“Lead maternity carers need to be aware of the NZ Sexual Health Society (NZSHS) recommendation to re-screen for syphilis in the third trimester, and all healthcare professionals need to be alert for possible congenital syphilis cases,” says Dr Sunita Azariah, sexual health specialist and spokesperson for NZSHS.

“Some hapū māmā continue to miss out on essential antenatal healthcare, including syphilis screening that is performed early in pregnancy,” says Dr Julia Scott, Public Health and Sexual Health Physician at the Institute of Environmental Science and Research.

The entire Northern health region introduced routine third trimester screening in May this year following successful implementation in Waikato and mid-Central regions plus a favourable cost-benefit analysis.

“Although infants with congenital syphilis are born to women who are less likely to have received antenatal care, repeat screening in the third trimester has the potential to detect and enable treatment of a number of these late infections preventing devastating health outcomes,” says Dr Best. It is estimated around one in four congenital syphilis cases had mothers with a normal first trimester screen.

Babies born with congenital syphilis can have fevers, enlarged liver and spleen, and skin rashes and those with no initial symptoms may develop problems over years including deafness, eye disease, seizures, and intellectual disability.

"We have learnt lessons from the pandemic on setting up public health infrastructure that is equitable and accessible. This must continue for other infectious diseases such as syphilis. Addressing poverty, structural racism, mistrust of healthcare and enabling appropriate access to free services needs to continue to be prioritised,” says Dr Best.