TO: All Providers
RE: Alabama Medicaid and ADPH Launch Joint Effort to Stop the Rise of Congenital Syphilis in Alabama
Since 2019, Alabama continues to report record high cases of congenital syphilis. The state reported 15 cases in 2019, 23 cases in 2020, and, alarmingly, 36 cases in 2021. Of these reported cases, 79 percent of the mothers received prenatal care, but prevention opportunities, such as syphilis testing for early detection and adequate treatment, were missed. The most missed opportunities to prevent congenital syphilis among prenatal care recipients in Alabama were lack of syphilis diagnosis early in the third trimester. Forty-four percent of these pregnant women had a negative syphilis test result at the first prenatal testing, but a positive test close to, or during, labor and delivery. Pregnant women in Alabama are at a higher risk of syphilis infection during late pregnancy. To learn more, visit https://www.alabamapublichealth.gov/std/syphilis-prevention.html.
Key Facts
• Women are at the same risk for acquiring a new STD, such as syphilis, whether or not they are pregnant.
• Untreated syphilis during pregnancy can cause miscarriage, stillbirth, prematurity, low birth weight, hydrops fetalis, or infant death shortly after birth.
• Babies born with congenital syphilis may be asymptomatic. Infected infants may also suffer with hepatosplenomegaly, snuffles (copious nasal secretions), lymphadenopathy, mucocutaneous lesions, pneumonia, osteochondritis, periostitis, maculopapular rash, hemolytic anemia, or thrombocytopenia at birth, or within the first four to eight weeks of life. Untreated infants, including those asymptomatic at birth, may develop late manifestations, which usually appear after two years of age. Children can have Central Nervous System (CNS) abnormalities, eighth cranial nerve deafness, interstitial keratitis, and other severe manifestations of disease.
• Early detection and treatment of syphilis in pregnant women is critical for the infant and far more cost-effective than treating an infant with complications of congenital syphilis.
Recommended STD Testing in Pregnant Women
• First/Initial Prenatal Visit: Screen for Chlamydia, Gonorrhea, Syphilis, HBV, HCV, and HIV infection (unless the patient is already confirmed to have HIV infection).
• Early Third Trimester (between 28-32 weeks gestation) Regardless of Risk Factors: Screen for Syphilis and HIV. If a person is already known to be HIV positive, the person does not need to be rescreened for HIV infection.
• Labor and Delivery: Test all pregnant women at the time of labor and delivery for Syphilis, HIV infection (Persons already known to be HIV positive do not need to be rescreened for HIV infection.) and HBV (if no prior HBV testing), or the patient has signs and symptoms of hepatitis.
Syphilis Treatment During Pregnancy
Due to missed opportunities resulting in a significant number of cases of congenital syphilis in Alabama, Alabama Department of Public Health (ADPH) is recommending the following treatment regimens, including re-treating women who were previously treated for syphilis before pregnancy.
All pregnant women with signs and symptoms and/or a positive syphilis test result must be treated, as detailed below, at least 30 days before delivery, to prevent congenital syphilis:
• Primary Syphilis, Secondary Syphilis, or Early Non-Primary and Non-Secondary Syphilis: Benzathine penicillin 2.4 million units IM every week for two weeks at 5-7 days interval.
• Syphilis Unknown Duration, Late Syphilis, or Previously Treated Positive before Pregnancy: Benzathine penicillin 2.4 million units IM every week for three weeks at 5-7 days interval.
Reimbursement
• Alabama Medicaid supports ADPH recommendations of testing pregnant women for Syphilis and HIV at the initial prenatal visit and again early in the third trimester of pregnancy due to the increase in congenital syphilis cases between 2019 and 2021.
• Alabama Medicaid covers payment for Syphilis and HIV screening/testing during pregnancy. Syphilis and HIV testing are reimbursed separately from the global maternity codes.
• If there are issues related to claims processing for these services, please contact the Provider Assistance Center at 1-800-688-7989.
ADPH Support:
ADPH offers free syphilis testing and treatment for pregnant women and their partners.
Reporting;
Points of Contact:
Dr. Burnestine Taylor, ADPH Bureau of Communicable Disease Medical Officer, 334-206-9380
Dr. Wes Stubblefield, ADPH District Medical Officer and Pediatrics Consultant, 256-340-2113
Dr. Karen Landers, ADPH Chief Medical Officer, 334-206-5200
Dr. Agnes Oberkor, ADPH Congenital Syphilis Coordinator, 334-206-3913
Mr. Anthony Merriweather, M.S.P.H., ADPH, 334-206-2765
Alabama Medicaid Provider Assistance Center, 1-800-688-7989
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