In a post-COVID-19 world, one of the byproducts of focusing on pandemic mitigation instead of public health outcomes across the state has led to an increase in congenital syphilis.

When the disease is passed from mother to baby, it can have life-threatening effects and, state health officer Dr. Dan Edney said, ultimately costs the state millions.

“We’re having an explosion of congenital syphilis like we’ve never seen, which is causing a lot of infant death and sickness with the babies and long stays in the hospital,” Edney said this week when addressing the Warren County Board of Supervisors. “That’s a result of cutting back on public health. We just don’t have the capacity that we did in 2015 to get out and work the cases like we need to do.”

At the local level, the Warren County Health Department devotes $25,966 in state funds to testing and prevention for HIV and other STDs. Connected to that number is the $18,990 of state funds spent annually on disease surveillance and response.

Dr. Geri Weiland, Immediate Past President of the Mississippi State Medical Association and a practicing pediatrician in Vicksburg, confirmed the congenital syphilis crisis is showing up in Warren County.

“It’s about people,” she said. “They’re not being as careful. They’re not really taking care of themselves. Sometimes, they may or may not be reporting their findings (to their physician).”

Part of the fight against congenital syphilis in Mississippi is an order issued by Edney through the Mississippi State Department of Health that requires all pregnant mothers to be tested for syphilis in their first and last trimesters. If the mothers are positive for the disease at birth, their babies must undergo rigorous testing as well.

If a newborn baby has to be treated for congenital syphilis, the baby has to stay in the hospital for a minimum of 10 days. Not only that, but Weiland said the testing baby must undergo can be painful.

“If your baby tests positive for syphilis, their workup must include a spinal tap,” she said. “You have to poke a needle in the (baby’s) back and make sure there’s no involvement in the brain at the time of the infection.”

A spinal tap is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid for diagnostic testing.

In mothers, syphilis presents as sores at the site where the bacterium entered the body — typically near the genitals, the rectum or the oral cavity. The sores are usually firm, round and painless. According to the Centers for Disease Control, secondary syphilis symptoms include fever, swollen lymph nodes, skin rash and wart-like genital lesions. In the latent stage, there are no signs or symptoms. In tertiary syphilis, several medical problems affecting the heart, neurologic system and other organs can be seen.

For babies, the CDC says some infants with early congenital syphilis are asymptomatic at birth. Clinical manifestations of early congenital syphilis might include sniffles, a skin rash, glaucoma, cataracts, anemia and thrombocytopenia.

Some clinical signs consistent with congenital syphilis might be detected by ultrasound during pregnancy. Infants who remain undiagnosed and untreated can progress to late congenital syphilis, resulting in numerous additional clinical manifestations, including, but not limited to saddle nose due to destruction of cartilage, frontal bossing due to periostitis, tibial thickening, joint swelling, perforation of the hard palate, abnormal tooth development, interstitial keratitis, neurologic deafness and blindness.

Infants might be born without clinical signs of syphilis but go on to develop late-stage manifestations of untreated congenital syphilis that include developmental delay, neurologic manifestations and late congenital syphilis physical signs.

“We’ve had a really interesting experiment in public health through the pandemic, where we could either keep the county health departments going or we could work on mass vaccination and pandemic mitigation. We couldn’t do both, and obviously, we had to take care of the population,” Edney said. “So for 18 months, county health departments were shut down.

“Now, we’re seeing what happens when you shut county health departments down,” he added. “All that to say is, everything is being invested very well for constituents, the community and families.”