Public health learnings and data gathered over the 40 years of the AIDS crisis can help officials tackle the rise of congenital syphilis, which increased 755% from 2012 to 2021 and another 30% in 2022. The Centers for Disease Control and Prevention (CDC) recently noted “missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy” as contributing factors to its meteoric rise. Public health departments and medical institutions should look to successful initiatives in the AIDS ecosystem, such as expanded at-home testing and linkage to care, to close testing and treatment gaps for congenital syphilis.
Early public health efforts around AIDS were hampered by a lack of accurate and timely messaging, which paved the way for a rise in stigma and misinformation surrounding HIV. This worked against patients who might otherwise have sought testing and treatment, and remains a factor in HIV care today. The overall decrease in HIV infections in recent years has been attributed to the expansion of HIV testing, timely treatment, and the prescription of pre-exposure prophylaxis (PrEP). Just as the AIDS crisis disproportionately impacted men who have sex with men, congenital syphilis impacts Black, Hispanic and American Indian/Alaskan Native mothers more than white mothers.
Public health initiatives can target at-risk patients in these communities with at-home testing programs, which already successfully screen patients for HIV and STIs around the country. Public health departments know their communities best and often have relationships with at-risk patient populations. For example, the Fulton County Board of Health in Atlanta developed an HIV/STI screening program based on the needs of their community to reach marginalized patients in the area, whose barriers to care included language concerns, immigration and deportation-related concerns, and sexuality-related cultural norms — not unlike concerns patients at-risk for congenital syphilis might have. Atlanta has some of the highest rates of HIV in the United States, and in the first year of the program, officials found that 40% of patients tested had not been tested for STIs the year prior, and 20% of patients had not been tested for HIV in the same period. Public health initiatives aimed at targeting congenital syphilis clusters could similarly target events with families, at-risk mothers, and other people who are pregnant or could become pregnant.
Attempts to reduce the impact of congenital syphilis should also entertain linkage to care models popularized by the HIV ecosystem. Linkage to care is a necessary precursor to antiretroviral therapy initiation and viral suppression, and the federal benchmark for care completion is meeting with a provider within one month or a reactive test result within a minimal timeframe. At-home testing programs targeting congenital syphilis could utilize the same linkage to care practice to connect pregnant people to treatment after testing to reduce stillbirth, miscarriage, premature birth and infant death. This is a powerful move for public health officials trained to work with populations at-risk for congenital syphilis, who have already earned community trust, rather than providers who may unintentionally trigger shame or use stigmatizing language.
At-home diagnostics programs based on HIV linkage to care models focused on Black, Hispanic and American Indian/Alaskan Native mothers and pregnant people at-risk for congenital syphilis can break down barriers to testing and treatment. Unlike the early years of the AIDS epidemic, public health officials already have tools to curb the spread, but it is crucial that these programs get off the ground quickly. Between 1981 and 1990, the CDC reported 100,777 deaths from AIDS, with a third of those deaths reported in 1990 alone. Without fast action, this could become a much larger and costlier epidemic for pregnant people and their children.
About David Stein
David Stein is the CEO of Ash Wellness, a B2B at-home diagnostic company launching remote care services for healthcare organizations and D2C businesses. Ash Wellness offers white-lable operations management, testing via a CLIA/CAP certified lab network, kitting and fulfillment, and modern technology infrastructure. In his role, David is responsible for mission vision, strategy oversight, fundraising, and corporate development. He is a graduate of the Cornell Tech MBA program.
