Health officials are alarmed by the growing number of babies born with syphilis in Maricopa County, and they're struggling to get doctors, midwives, and nurses to pay more attention to the problem.
Last year, 30 babies were born with congenital syphilis — a significant jump from 20 in 2017 and 14 the year before, according to recently released statistics from the Maricopa County Public Health Department.
Five of the babies born with the disease last year died.
It’s not just syphilis on the rise. Rates of gonorrhea and chlamydia are going up, too, in Maricopa County and throughout the United States. The only sexually transmitted disease that isn't increasing in the county is HIV. Meanwhile new cases of gonorrhea have skyrocketed, tripling between 2010 and 2016.
Last year, the CDC said that nationwide rates of syphilis, gonorrhea, and chlamydia had risen for the fourth year in a row, with a record-breaking 2.3 million diagnoses in 2017.
“Why we’re seeing such a resurgence in STDs, I don’t really know,” said Dr. Rebecca Sunenshine, an infectious disease specialist and the medical director of disease control for the Maricopa County Department of Public Health. She theorized that one culprit could be “message fatigue” about using condoms.
“A lot of people will be worried about birth control, and they’ll have that taken care of, but when it comes to STDs, they don’t want to use condoms,” she added.
Because congenital syphilis is preventable and can be treated with antibiotics, the county is trying to get more doctors and midwives to screen for the disease among pregnant women. If they are not miscarried or stillborn, babies born with syphilis can suffer from a range of serious health problems, including physical deformities and neurological problems. They can also die early in life because of the disease.
Last year, 20 percent of the mothers who gave birth to babies with congenital syphilis reacquired the disease during pregnancy, after they were treated once, according to Sunenshine. In some cases, she said, the first time pregnant women received medical care was when they arrived at the hospital, ready to deliver.
This type of delay can worsen the effects of syphilis on a baby.
White women comprise a clear majority of mothers giving birth to babies with syphilis, county statistics indicate, although the numbers are rising among Hispanic and Native American women. For instance, last year, a little more than a third of such mothers were Hispanic, compared to just over a quarter in 2014.
State law requires medical providers to screen pregnant women in their first trimester or at their first prenatal checkup, whichever comes first.
Now, county health officials are requesting that these providers also screen women during the third trimester and after giving birth, and they’ve issued a public health order in January to that effect.
This order is not new, though. It's virtually identical to a congenital syphilis public health order that was issued two years ago that asked the same thing of doctors and midwives.
After the county issued that order, syphilis rates did not go down. That begs a few questions, like why the county is addressing the same problem with a solution that wasn't too effective last time.
Sunenshine said that the county’s public health order was just one component of its "multi-pronged" efforts to address congenital syphilis. It is working with the CDC to create a curriculum for continuing medical education credits, which doctors and nurses are required to take. She said the county planned to conduct grand rounds — when doctors, nurses, and hospital staff in a particular specialty will get together for an educational lecture — on congenital syphilis, although she had only one such event scheduled so far.
The actual impact of the public health order is hard to gauge, Sunenshine said, because it’s hard to discern medical providers' awareness of it. Meanwhile, the county has no way of checking that doctors and midwives are screening women at later stages of pregnancy, she said.
“Our job is to support and educate,” Sunenshine said. “The public health order is, unfortunately, not enforceable.”
For its STD programming, the Maricopa County Public Health Department gets about $2 million (including funding for HIV) from the county general fund; $410,000 from fees that the county charges for testing and treatment; and about $1.2 million in federal grants from the CDC, of which only $411,000 is for non-HIV diseases.
Jeanene Fowler, a spokesperson for the department, said that funding had been “pretty constant” for the last few years — even as rates of non-HIV STDs grow.
Funding is not high enough to investigate every reported STD case.
Medical groups point to different causes of the growing rates of STDs — inadequate sex education; doctors and nurses who still aren’t comfortable talking with their patients about sex; or a lack of access to affordable testing and treatment.
Laura Dearing, the executive vice president of the Arizona Academy of Family Physicians, said that many of the organization’s members (she couldn’t provide a specific proportion) have opted not to offer obstetric services, “due to the high rates of malpractice insurance.” She wrote in an email to Phoenix New Times, “Tort reform would definitely help alleviate this problem.”
Providers like Planned Parenthood also blame Arizona’s disjointed system of sex education, in which curriculum is determined by school districts, and parents have to opt in.
“There are certain people that are getting comprehensive sex ed, certain people that are getting nothing at all, certain people that are getting abstinence-only,” said Tayler Tucker, a spokesperson for Planned Parenthood Arizona.
In Arizona, parents can choose to enroll their children in sex-ed classes, which are not required. A bill currently in the Senate would change that to an opt-out system and mandate that sex ed classes are age-appropriate and medically accurate, which means they would discuss contraception. That bill has been read and assigned to a committee, but not scheduled.
“The lack of sex ed that is state-mandated puts our populations at risk here in Arizona,” Tucker added.
If people who don't have health insurance wanted to get tested, they can go to Maricopa County’s STD clinic, which tests, diagnoses, and treats people and charges fees on a sliding scale, said Sunenshine. She also directed potential patients to two websites, FindHelpPhx.org, which has a list of free or low-cost health clinics, and STDaz.com.