Congenital Syphilis: A Looming Concern for India?

Dear Editor, Syphilis, a sexually transmitted infection (STI), has been dubbed “The Great Pretender” due to its chameleon-like ability to mimic a variety of other diseases and its changing symptomatology over time. Congenital syphilis (CS) is a form of the disease that is transmitted from an infected mother to her fetus via the placenta if the mother does not receive timely and effective treatment.[1] Even though mother-to-child transmission of syphilis is largely preventable through proper identification and treatment during pregnancy, it continues to be a major global problem. CS can lead to severe consequences, such as miscarriage, stillbirth, premature birth, or even the death of the infant.[2] In the 1940s, with the widespread availability of effective antibiotic treatment, syphilis was believed to have been nearly eradicated in the US. As a result, healthcare professionals, such as doctors, nurses, and clinical staff, rarely encountered patients with syphilis in their practice. However, over the past decade, cases of syphilis have begun to re-emerge. According to the centre for disease control and prevention (CDC), the national rate of total syphilis infections increased by 175% (from 14.8 to 40.6 cases per 100,000) between 2014 and 2020. This alarming rise in the number of newborns born with syphilis has prompted US public health professionals to call for urgent action. Updated CDC data shows that in 2022, over 3,700 babies were born with syphilis, more than 10 times the number in 2012. A recent study included in the CDC’s Morbidity and Mortality Weekly Report states that nearly 300 of these infants either died or were stillborn.[3] The resurgence of Congenital syphilis can be attributed to several factors, including limited access to healthcare, homelessness, unemployment, and drug abuse. In almost one-third of the cases, the mothers who were infected either had not been tested at all or had not been tested in time for a successful intervention. One strategy, among many, is to prioritize testing and treatment for the most vulnerable groups—young people and adolescents, men who have sex with other men, and expectant mothers. Another option is to integrate sexually transmitted infection (STI) testing and treatment into relevant public health initiatives, such as those addressing drug abuse disorders. More targeted approaches are needed to ensure that women who are more likely to transmit syphilis to their fetuses receive appropriate prenatal care, to monitor these women, and undergo adequate screening. These strategies include focused outreach initiatives, coordination among service providers, and specific components of prenatal care.[4,5] The question then arises: is an emerging nation like India at risk given the situation in wealthier nations? The Elimination of Parent-to-Child Transmission (E-PTCT) of syphilis was a nationwide policy launched in 2015 by the STI/RTI Control and Prevention program under NACO, in conjunction with the Reproductive, Maternal, Newborn Child Health, and Adolescent Programmed (RMNCH+ A) under the National Health Mission. In low-socioeconomic countries like India, syphilis has been included in the basic prenatal care package in conjunction with RMNCH+ A.[4] This initiative aims to provide universal coverage for all pregnant women to meet elimination targets. However, several common issues in low socioeconomic countries hinder the effectiveness of these programs: 1) a lack of trained personnel and guidelines regarding who can perform syphilis testing, which affects the routinization of syphilis screening for all pregnant women; 2) limited knowledge among providers and the community about the burden of maternal syphilis-related outcomes due to limited information, education, and communication activities on the subject, the asymptomatic nature of the infection, a perception among health-care providers that syphilis is no longer a problem in India, and poor reporting along with a lack of surveillance; 3) late ANC attendance; and 4) missed opportunities for syphilis testing and treatment.[5] These challenges must be addressed to ensure the success of the E-PTCT program and to protect the health of mothers and their babies, as this could lead to tragic outcomes like birth defects, developmental delays, and even infant mortality. To mitigate this threat, India needs urgent action: strengthening awareness campaigns, ensuring universal access to prenatal syphilis screening and treatment, and addressing healthcare disparities. Protecting our mothers and babies from this preventable disease requires swift and proactive measures. Author contribution Conceptualization of the study by SM, writing original draft by PE, Writing, PE and editing done by NG, TN AND SM. Financial support and sponsorship Funding received from Dr. D. Y. Patil University, Pune. Conflicts of interest There are no conflicts of interest.