Over the last decade or so, a serious epidemic has emerged in Arkansas. It’s not COVID, the flu, or even RSV. Pregnant women in Arkansas have experienced a fivefold increase in congenital syphilis rates since 2017, well surpassing the number of perinatal HIV cases seen at the height of the HIV epidemic. Nevertheless, providers and healthcare specialists can help moms fight this uphill battle through education and preventive care initiatives.
Mallory Jayroe, an infectious disease epidemiology supervisor and SET-NET coordinator at the Arkansas Department of Health, recently appeared on AFMC TV to discuss this alarming rise in syphilis and the urgent need for prenatal testing.
A Widespread, Yet Preventable, Crisis
Congenital syphilis isn’t just confined to Arkansas. Mallory says it’s impacted almost every state, with the highest rates in the southern U.S. Like other sexually transmitted infections, however, syphilis can be prevented through practicing safe sex and getting tested regularly.
When passed from the mother, syphilis can significantly affect the baby’s health. Syphilis can cause a baby to be born with an enlarged spleen, rashes, or, in the worst cases, cause a stillbirth or death shortly after birth.
Through the CDC-funded Surveillance for Emerging Threats to Mothers and Babies project, SET-NET, Mallory and her team collect data from medical records, interviews, or other means to understand more about syphilis affecting pregnant women and congenital syphilis (when syphilis is passed from mom to baby during pregnancy).
“That’s how we’ve identified trends like substance use and mental health challenges,” Mallory says. “We send data back to the CDC, which helps inform national prevention efforts and brings resources back to Arkansas.”
SET-NET plays a vital role in collecting ground-floor data that directly impacts Arkansans, which is critical to saving moms and babies from preventable diseases through research and education.
Maternal Health Deserts Exacerbate the Issue
Data reveals a lack of prenatal care in maternal health care deserts in Arkansas, preventing so many women from getting the care they need.
“We also see a high rate of substance use in our cases, which increases the risk of syphilis transmission,” Mallory says.
Rates are currently high in central and Northwest Arkansas. Many moms in those areas are getting prenatal care, but data still shows congenital syphilis cases statewide. In places with limited access to care or testing, the number of cases may actually be more than what the data shows.
Treatment Options
Pregnant women should take penicillin, not doxycycline, for syphilis. If a woman is allergic to penicillin, she must be desensitized, which can be done by a pharmacist. Penicillin is the gold standard for syphilis treatment.
“We typically see women being tested and treated, but their partners often aren’t,” Mallory adds. “If their partners aren’t treated, too, reinfection can happen, and we’re back to square one. That’s why partner education and treatment are also critical.”
Overcoming Stigma through Education and Policy
Like other STIs, syphilis carries a lot of stigma. Many people feel ashamed that they have contracted it and may avoid getting tested or discussing their sexual history with a provider. While understandable, stigma prevents timely testing and treatment and continues the spread.
An Arkansas law may help overcome that stigma by increasing screening for syphilis before and during delivery.
“In Arkansas, there’s a law requiring syphilis testing in the first and third trimesters, and again at delivery if needed,” Mallory says. “With those tests, we should be able to catch and treat syphilis more easily.”
The law passed in 2021, meaning many providers may have missed it. Mallory and her team conduct outreach initiatives to educate providers and ensure they know about the law.
“We want both providers and women to know the law. Syphilis was nearly eradicated in the early 2000s, so some providers have never seen a case. If a provider forgets or doesn’t know, we want women to feel empowered to advocate for themselves and ask to be tested.”
Anyone who is sexually active is at risk for STIs and should get tested. Mallory and her team hope to eradicate the stigma surrounding syphilis and encourage testing before, during, and after delivery.
Available Resources and Statewide Initiatives
The Arkansas Department of Health and the CDC websites offer plenty of resources about STIs, including syphilis. Most providers also use the Red Book, a key reference for infectious disease treatment and testing. Mallory and her team recommend that all providers use it.
Mallory and her team also work with the Arkansas Perinatal Quality Collaborative on a six-month pilot initiative in which all moms are tested at delivery, regardless of prior testing or treatment. Twenty-two hospitals across the state are participating in the pilot, which will help catch infections missed during pregnancy or if a mom is reinfected.
“We’ve already identified two cases where moms tested negative early on but were positive at delivery. We’ll have data to share around September,” Mallory says.
Congenital syphilis is a growing but preventable public health crisis in Arkansas. With rates rising rapidly and tragic outcomes impacting babies and families, awareness and early action are more critical than ever. Routine testing during pregnancy, provider education, and destigmatizing STI care can save lives. Programs like SET-NET and statewide pilot initiatives are working to close the gap, but lasting change depends on collaboration across providers, partners, and communities.
