Laurie Ayala works from an office deep inside Northwestern Medicine’s Prentice Women’s Hospital in Chicago, Illinois. When the little, black landline phone on her desk rings, she answers. This phone is the headquarters for Illinois’ Perinatal Syphilis Warmline. The phone line, which will be launched in November 2023, is intended to answer questions concerning perinatal syphilis from medical practitioners around the state.
The phone line was established in response to a significant spike in congenital syphilis cases in Illinois and across the country, which happens when the syphilis infection spreads from mother to baby during pregnancy. In 2022, around 4,000 newborns were born in the United States with syphilis, up from 335 in 2012.
The warmline serves as a triage center for inquiries regarding test interpretation, diagnosis, and therapy. The prenatal syphilis hotline expands on Illinois’ perinatal HIV hotline, which was launched statewide in 2005. These phone lines are familiar to Ayala, who has been in public health for 18 years and has worked on the HIV hotline from its inception.
“There’s nothing like being able to pick up a phone and get a recommendation on your specific patient’s situation,” Ayala said in a statement.
The causes for the increase in instances are numerous. Dr. Helen Cejtin is an obstetrician-gynecologist at Chicago’s John H. Stroger Jr. Hospital. In November, she co-authored a Morbidity and Mortality Weekly Report for the Centers for Disease Control and Prevention, which examined how COVID may have affected congenital syphilis cases in Chicago. The first thing she mentions is insufficient testing and prenatal care.
“You have a huge chunk that’s just someone not getting prenatal care,” Cejtin tells me. “So, why is this happening? Were they… uninsured, unable to see a doctor, homeless, and without transportation?
According to the CDC, around 40% of people who gave birth to babies with congenital syphilis did not obtain prenatal care.
Some people are diagnosed but do not get or complete treatment. A pregnant individual with early-stage syphilis can be treated with a single injection of Bicillin L-A, a kind of penicillin. The recommended treatment for late-stage syphilis is three shots spaced 7-9 days apart. To be considered effective, treatment should begin at least a month before delivery.
Medical experts identify tough commutes, the need to take time off work, and a lack of access to childcare as significant hurdles to treatment for their patients.
The CDC determined that prompt testing and treatment might have avoided around 90% of the 2022 cases. Because of these hurdles to treatment and prenatal care, congenital syphilis affects underprivileged communities more than others.
Dr. Lynn Yee, an associate professor of obstetrics and gynecology at Northwestern University, serves as the warmline’s medical director.
“It becomes concentrated in communities in which people are more underprivileged, less resourced in medical care,” she said. “In the United States, that disproportionately means people who are marginalized in other ways.”
Syphilis, according to Yee, is a syndemic – when two or more illnesses interact with one another – exacerbated by poverty, structural racism, and a lack of healthcare access.
“It just really emphasizes how our society lets certain communities down over and over again – especially considering how treatable it is,” she said.
According to CDC data, kids born to Black, Hispanic, and Native mothers were up to eight times more likely to have neonatal syphilis in 2021 than babies born to white moms. Black babies in the United States had double the mortality rate as white babies. In terms of demographics and availability of care, Black mothers were twice as likely as white mothers to receive late or no prenatal treatment in 2020.
Medical personnel who are unfamiliar with the disease may struggle to interpret test findings to diagnose syphilis and determine the best course of treatment. The warmline crew intends to serve as a data center, answering queries, searching treatment records, and attempting to limit the number of patients who fall through the gaps.
Other alternatives proposed by experts include greater screening and the use of mobile health units to deliver therapy directly to pregnant people. Dr. Yee also emphasizes the need for broad, policy-based solutions.
“What you need isn’t just treatment during pregnancy and public health systems focused on pregnancy, you need systems that help people be as healthy as they possibly can before they even get pregnant,” she said.
The Illinois Perinatal Syphilis Hotline can be reached at 1-800-439-4079. It is open Monday through Friday, from 8 a.m. to 4 p.m. CT.
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