Doctors Baffled by Syphilis Return in Newborns

The stuffed animals and music box that surround the tiny boy sleeping in his crib are gifts. The bright lights, tubes and alarms are necessities.

He’s 14 months old, but weighs only 13 pounds. He takes nourishment from a tube attached to his swollen abdomen, oxygen from another under his nose. The stainless steel crib inside Carolinas Medical Center has been home for all of his brief and pain-filled life.

The boy was permanently scarred at birth by syphilis, passed to him in his mother’s womb. He’s one of an increasing number of babies in the United States born with the disease, health officials say.

Doctors say they are frustrated that so much suffering is caused by a treatable disease--and they blame poverty and drug use in part for its resurgence.

“Four or five years ago, congenital syphilis almost disappeared,” said Dr. David Fisher, the neonatologist who is treating the boy at Carolinas Medical Center. “There seems to be a clear correlation between the use of crack cocaine and selling sex for drugs.”

The Centers for Disease Control in Atlanta reported 4,352 such cases of afflicted babies in the United States in 1991, 689 more than the previous year.

Since the last decade, the leap has been more than fourfold: The numbers were fewer than 1,000 per year in the 1980s.

New York had only nine cases in 1982. Last year, it had 1,073 cases. California’s caseload jumped from 24 in 1982 to 647 last year. And in North Carolina last year, 53 babies were born with syphilis. Only 35 cases were reported in 1990 and fewer than five cases annually in the 1980s.

Nineteen syphilis babies born in North Carolina last year died; no deaths were reported in the three previous years.

“We’ve seen a doubling of cases over the last couple of years,” said Dr. Cathy Wilfert, chief of the division of Pediatric and Infectious Diseases at Duke Medical Center. “And it’s not just in Raleigh and Charlotte and Durham. It’s a pervasive problem wherever drugs are available, in all 100 counties.”

Some of the increased numbers are being attributed to improved reporting. All babies born to mothers with untreated syphilis are counted, for example, whether or not the babies show symptoms of the disease. Until 1990, babies were counted only if they had symptoms.

But health officials also cite the crack cocaine epidemic and lack of prenatal care.

“We are seeing an increase in syphilis, especially among women who live in a world of poverty and sex for drugs,” Wilfert said. “It’s the population that’s least able to handle it.”

The odds were stacked against the mother of the boy in Charlotte, said Dr. Allyn Nakashima, who tracks congenital syphilis at the CDC.

“The highest risk population are minority women from the inner city,” she said. “Afro-American women are at risk at a rate 50 to 60 times higher than other populations. Other factors are use of crack cocaine and multiple sexual partners.”

The boy’s mother, 20 and already a single mom when she became pregnant, isn’t from a big city but does come from the South, where efforts to eradicate syphilis after World War II were not as successful as in other regions of the country, Nakashima said.

“In 1990, rates in the South were 33 per 100,000 while the rate in the Northeast was 20 per 100,000,” she said. “It’s a bigger problem and more widespread in the South, urban and rural. In other regions, it’s restricted mostly to the urban areas.”

The doctor said many of the high-risk mothers have such complicated lives that they don’t care for themselves or their babies.

“The stigma of syphilis is really not the biggest barrier,” she said. “They just don’t avail themselves of prenatal care.”

The small boy at Carolinas Medical Center, whose name was withheld at the request of his family, needs almost constant attention, nurses said.

He sometimes becomes so irritable that he must be sedated.

“Sometimes the music is the only thing that calms him down,” nurse Diane Miller said, referring to the music box in the boy’s crib.

Miller, who has worked in the hospital’s neonatal unit for nearly 15 years, said the boy smiles when parents of other infants pass his crib. He also enjoys sitting up in a safety seat, but can’t remain in that position for more than a few minutes.

The boy’s liver is enlarged and he has trouble absorbing food through the feeding tube. His lungs are permanently damaged, he has neurological problems and he is susceptible to viruses.