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Syphilis Increase & Congenital Infection Prevention

December 12, 2016

Situation Report

  • Syphilis transmission is increasing in Pierce County and nearby counties.
  • Heterosexual cases are occurring as well as among men who have sex with men.
  • Neurologic and ocular involvement has been reported more frequently than in prior years.

Requested Actions

  • Test all pregnant women for syphilis at the first prenatal encounter.
  • Repeat syphilis testing during the third trimester among women at risk for STD (e.g., recent history of bacterial STD, multiple partners, homelessness; methamphetamine, opioid, or cocaine use; exchanging sex for money, drugs, etc.; having a sex partner who is a man who has sex with men).
  • If a mother delivers with no syphilis serology on record, ensure completion of syphilis serologic testing prior to discharge of the mother and baby.
  • Within three days, report any clinical or laboratory evidence of syphilis in pregnant women, delivering mothers, or their infants to Tacoma-Pierce County Health Department at (253) 798-6410.
  • Within three days, report all suspected and confirmed cases of syphilis to Tacoma-Pierce County Health Department at (253) 798-6410.


  • Infectious (primary and secondary) syphilis cases have increased in Pierce County more than 4-fold over the past half-dozen years (see figure).
  • Comparing the first three quarters of 2015 to 2016, infectious cases in Pierce County have again increased 55% from 33 to 51 cases. Early latent cases also have increased 80% across the same interval from 25 to 45.
  • Analogous increases are occurring statewide, particularly in larger urban areas (e.g., King, Spokane, Snohomish and Yakima Counties).
  • These increases raise concern because syphilis is known to facilitate the transmission of HIV. During 2016, 37% of infectious cases reported in Pierce County have occurred in HIV-infected individuals.
  • In Pierce County, females accounted for 3 (5%) of 58 primary, secondary, and early latent cases in 2015 and 4 (4%) of 96 cases in 2016. This is a reminder that syphilis transmission is not limited to men who have sex with men and it raises concern for the potential of congenital syphilis cases occurring.
  • Two congenital syphilis cases were reported in Pierce County, one in late 2015 and one this year. Of these two cases, both involved missed opportunities for prenatal care providers to test and make an earlier diagnosis.

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