Congenital syphilis as a lens

 I was in college when I discovered how interesting microbiology was. I majored in it and found the courses in medical school equally interesting. I did a senior year rotation in infectious diseases at Temple under Bennett Lorber, then a new assistant professor fresh from his infectious diseases fellowship. This was in January 1974 and I was hooked. The Navy offered me a fellowship in 1981 after a tour as a general internist at Naval Hospital Guantanamo Bay; I then spent two years at Naval Hospital San Diego which was tremendous fun as well as accelerated learning.

The program at San Diego was also a shaping one. The problem of sexually transmitted diseases, especially gonorrhea, drove the research part of my fellowship. Little did I know how it would affect me for the remainder of my medical career. At Naval Medical Center Portsmouth Virginia, a full decade of running an HIV Evaluation Unit with Margan certainly cemented the importance of these diseases in my psyche. Upon retirement from the Navy, I was hired as Medical Director for the STD/HIV Division of the Chicago Department of Health. And this is where I need to introduce an article that formed the nucleus of today’s rambling.

ProPublica published “Babies are dying of syphilis. It’s 100% preventable.” on 1 November 2021. It’s not long and I think it is a good read for anyone interested in public health (and it is a break from Covid-19). A young disease investigator is trying to find a pregnant woman who tested positive for syphilis and convince her to get treated so that she and her unborn child would be spared the ravages of syphilis. Caroline Chen, the author, also gives a capsule history of syphilis through history. She notes that in 1937, the then Surgeon General, Thomas Parran, estimated that 60,000 children were born each year congenitally infected with syphilis. While treatment with penicillin is inexpensive (although Chen quotes Dr. Ina Park of UCSF that the cost to public health clinics is tiny compared to the cost of penicillin to medical offices), the resurgence of cases over the past decade coupled with multiple stories of missed opportunities to treat pregnant women with syphilis means that we continue to have a failure of public health with this disease.

When I was in Chicago from 2002 to 2004, the CDPH worked with CDC to address syphilis as a priority. Most of the cases were with MSM (men having sex with men) but we continued to see congenital syphilis. The disease investigators I supervised did the same dogged job described in Chen’s article. But when funding was reduced, the spirochete of syphilis roared back to life. It always has. 

There are many causes for the rise of syphilis and other STDs. From the two years I worked in Chicago, it became clear that the real problems are primarily inequality and poor access to services. That is part of our overall approach to healthcare in the United States. Add to that the persistent and unnecessary stigma of STDs and one can see that programs designed to fund eradication efforts (such as the one I walked into in Chicago) are destined to be no more than a temporary bandage over the problem of STDs. Of course, the devastation of the Covid-19 pandemic on top of a poorly funded public health system creates an unknown factor for the future.

Maybe someday as a nation, we will realize that healthcare is a human right. We ought to realize that prevention is always more cost-effective when compared to treatment. There is no reason that any baby should be born with congenital syphilis. I won’t live to see the epiphany; perhaps you will.