MDH updates screening recommendations

Twenty-nine cases of congenital syphilis (including three stillbirths) were reported to the Minnesota Department of Health (MDH) in 2023, according to preliminary data. This represents the highest case number in at least 40 years.  

Syphilis is a sexually transmitted disease that can have very serious complications when left untreated, but it is simple to cure with the right treatment. Congenital syphilis occurs when a pregnant person passes their syphilis infection on to their fetus during pregnancy, which can cause severe complications such as miscarriages, stillbirths, premature birth and brain/nerve problems (including blindness and deafness).  

The increase in congenital syphilis is especially troubling because it can be prevented through early detection and treatment. As recently as 2013 and 2014, there were no cases of congenital syphilis in Minnesota.

The increase in congenital syphilis cases follows an alarming increase in cases of all syphilis in Minnesota, and nationally, in recent years. Details are available at Syphilis Outbreak Response and Case Counts.

“It is heartbreaking to see this surge in congenital syphilis in Minnesota and nationally,” said Minnesota Commissioner of Health Dr. Brooke Cunningham. “Congenital syphilis is preventable by timely diagnosis and treatment.”

Due to the rising number of congenital syphilis cases, MDH has updated screening guidelines for health care providers. The updated recommendations state that all pregnant people should be screened at least three times during pregnancy, including at the first prenatal encounter (ideally during the first trimester), around 28 weeks of pregnancy and at delivery.

“Obstetrician-gynecologists will continue to be committed to ensuring that patients are screened for congenital syphilis so that they have the opportunity to be appropriately treated” said Dr. Elizabeth Slagle, chair of the Minnesota Section of the American College of Obstetricians and Gynecologists (ACOG). “We support the updated MDH recommendations, which are in response to the increase in syphilis. The CDC recommends additional screening in areas that have high rates of syphilis, and the CDC treatment guidelines are endorsed by ACOG. Congenital syphilis can cause serious health problems for infants, but it is preventable with a simple blood test and treatment.”

“The Minnesota Department of Health is working with partners in a variety of settings to improve access to testing and treatment for Minnesotans. We can work together to ensure that we do not have congenital syphilis in Minnesota,” said Dr. Ruth Lynfield, state epidemiologist and medical director at MDH.

Syphilis can affect anyone. Minnesotans of all races, ethnicity, gender and/or sexual orientation are increasingly impacted by syphilis. However, people who identify as American Indian/Alaska Native (AI/AN), Black and Latine/Hispanic are disproportionally impacted by syphilis due to a combination of factors affecting the social determinants of health, including differences in health insurance coverage, employment status, and access to preventive, screening, and curative services.

“We know that although Minnesota is one of the healthiest states in the country, not all of our communities are afforded the same opportunities for health,” said Dr. Nathan Chomilo, medical director for the State of Minnesota’s Medicaid and MinnesotaCare programs. “The updated congenital syphilis screening recommendations are an important tool to help close some of those gaps. Ongoing, additional community investment and outreach are needed to address the root causes of our state’s health disparities.”

In response to the increased burden of syphilis among all genders and sexual orientations in Minnesota, MDH recommends that providers consider syphilis screening for all sexually active people.  

MDH is working directly with health care providers to improve understanding of signs and symptoms, as well as routine screening, treatment and prevention of congenital syphilis. Because some pregnant people may not access traditional prenatal care, MDH will work with additional partners to increase screening for syphilis through partnerships with emergency departments, urgent care centers, correctional facilities, harm reduction/treatment providers and primary care clinics.

In addition to working with health care providers and partners, MDH will be working to share information directly with impacted communities about testing and treatment.  

Additional data and information about syphilis can be found on the MDH website: Syphilis.