The woman said she was tormented by pain and disbelief on the hospital bed, her stomach was smooth with ultrasound gel, when a hospital worker delivered the news: There was a baby inside.
It was a boy. Six months together.
And his heart wasn’t beating.
For months, the 30-year-old had waved her swollen stomach and ankles. Pregnancy seemed impossible because she had a history of difficulty getting pregnant.
She also said, “When you’re high, you push back all the bad thoughts.”
It wasn’t until days later, when she was mourning her unexpected baby at home in Los Angeles County, that a nurse called to tell her what happened, she said. She calls it “the S”, a disease that she is still embarrassed about.
More and more LA County’s babies are becoming infected with syphilis in the womb, which can lead to stillbirths, neurological problems, blindness, bone abnormalities, and other complications. Nine years ago, only six cases were reported across LA County, according to a Department of Health report. Last year, that number reached 113.
Numbers were already rising before the arrival of COVID-19, but public health officials fear the pandemic has made the problem worse, have closed clinics that screen people for syphilis and other sexually transmitted infections, and make new efforts to fight the disease.
The woman, whose baby was stillborn, who spoke on condition of anonymity to protect her privacy, said she went into labor in a hotel room in January. Despite the painful wounds, she had avoided getting medical help.
At the time, she feared that visiting a clinic could result in jail time for meth use. “You think, ‘I’m going to get in trouble because I’m high,'” she said.
The rise in congenital syphilis is particularly frustrating for experts as the disease can be thwarted if pregnant women are tested and treated in a timely manner. Other countries are credited with halting mother-to-child transmission of syphilis in recent years, including Thailand and Belarus.
Federal officials once thought the United States was about to join them. Instead, cases of congenital syphilis have skyrocketed across the country, from 334 cases in 2012 to more than 2,000 in 2020.
“There has been no sustainable investment in the years it took us to truly eradicate syphilis,” said Mario Pérez, director of HIV and STD Programs in the LA County Department of Public Health.
Experts have linked the wider rise in syphilis to a tangle of factors, including methamphetamine use and condom-free sex. Men who have sex with men have been particularly at risk, but the rise in the number of women and babies has been particularly alarming to health officials about the potentially devastating consequences.
Syphilis is curable in an infant if it is recognized and treated in good time. Mikhaela Cielo, infectious disease pediatrician at LA County-USC Medical Center.
The disease has acted like a kind of bleak prism that breaks societal problems such as addiction and homelessness. In LA County, up to two-thirds of mothers who had passed syphilis on to their babies reported using drugs while pregnant, according to Department of Public Health studies of cases between 2016 and 2018.
Between 10 and 20% were unhoused. 40 percent have never had prenatal care. And nearly 30% had a history of arrest or imprisonment. Eight cases of syphilis had been confirmed in 170 pregnant patients in LA County prisons by the end of August, said Dr. Noah Nattell, who is in charge of the county’s health department for women’s health.
The LA County Department of Public Health’s mobile clinic works with the People Concern and the Los Angeles Christian Health Center to test people for syphilis, hepatitis C, and HIV, as well as offering hot meals and other necessities.
(Mel Melcon / Los Angeles Times)
Syphilis is rarely confined to prisons, but “any systems that are in place that result in someone being incarcerated,” he said, “are also those that result in people avoiding or being excluded from the medical system. ”
The disease also reflects racial inequality: the vast majority of syphilis cases reported in LA County women of childbearing age were Latina and black women, according to county statistics.
The woman who lost her baby said she started using meth at an overwhelming point in her life when she faced the demands of a stressful job, school, and relationship that followed her previous struggle for one Pregnancy had become tense.
Back then, the drug felt like “a ticket to freedom”. She quit her pointless job. Your friend moved out. Meth made her feel brave, “like I could finally take a deep breath.”
She started meeting a man who told her he didn’t need a condom on her, a decision she now considers naive. After they broke up, she started a relationship with a friend who would become her baby’s father.
When waves of pain rolled over her in a hotel room where she was spending time with her boyfriend, another man, and his girlfriend, the friend quickly realized she was in labor and urged her to call 911, she said. But the men resisted the idea, she remembered, because there were drugs there and they didn’t want the police to pay attention.
Jennifer Wagman, associate professor of community health sciences at UCLA Fielding School of Public Health, said the rising incidence of congenital syphilis across the country was a sign that opportunities to stop the disease have been missed. Researchers have found that despite urging health officials nationwide, not all pregnant people are screened for syphilis.
According to an analysis by the U.S. Centers for Disease Control and Prevention, nearly a third of pregnant women with syphilis did not receive the care they needed even when diagnosed. Wagman said many reasons are linked to other problems in their life: Some are not insured. Some may have been tested but didn’t get any results or treatments because they don’t have a regular address or phone number.
And some fear that if they see a doctor and are found to be using drugs, they may be forced to abandon their child. The LA County’s report found that between 2016 and 2018, at least 30% of babies with congenital syphilis were taken into custody by the Department of Children and Family Services.
County officials said doctors could report child safety concerns to the DCFS, but it was “only in the most extreme cases” that an infant would be removed after an examination after birth rather than during prenatal care.
The LA County woman had also feared after her baby was stillborn that she could face criminal charges for having meth in her pregnant body – something that has led to charges for other women in California. At one point the morgue told her to put the cremation on hold because “the state was involved,” but no charges followed, she said.
Some experts see the resurgent disease as a symptom of poor sexual health. Jeffrey Klausner, clinical professor of population and health sciences at USC’s Keck School of Medicine, said federal funding collapsed about 15 years ago, followed by cuts for public health officials due to the recession that followed.
In a county as large as Los Angeles, he argued, there needs to be a proactive STD strategy that reaches affected communities. Instead, “everything was very piecemeal, reactive and incoherent”.
The pandemic didn’t help. A state survey found that most health courts that responded had more than half the workforce assigned to COVID-19 duties since September last year.
Reported cases of syphilis have fallen across California, but officials warn that this could be due to fewer tests. Many of the clinics where the LA County Department of Public Health offers STD screening, diagnosis, and treatment were temporarily closed during the pandemic.
Plans to create a new team focused on “responding quickly” to syphilis cases – including providing tests to people in homeless camps – have derailed. Nurses, who usually handle cases of women diagnosed with syphilis, were involved in coronavirus chores, which meant others to do the job, each handling 30 to 40 cases in addition to their other duties, said Dr. Sonali Kulkarni, Medical Director, District Division of HIV and STD Programs.
In August, the Los Angeles County Commission on HIV warned that “an already understaffed and inadequately resourced STD response was made worse by the redeployment of nearly all employees to COVID-19 work.” The majority of the district and community programs were “greatly reduced in their capacity or put on hold”.
Ciara DeVozza, left, a program director at People Concern, and Janice Johnson chat while they wait for the mobile clinic’s test results. In order to reach people who are being marginalized, “says DeVozza,” you have to look for them out here to make them feel safe. ”
(Mel Melcon / Los Angeles Times)
A rare exception is a mobile clinic on Skid Row, established during the pandemic by the Los Angeles Christian Health Centers, People Concern, and the county’s Public Health Department to test people for sexually transmitted infections.
Since his rapid test detects any exposure to syphilis, including previous infections, more blood must be drawn to check for a current infection. Getting these results can take days, which can mean tracking patients down the street. The Skid Row promotion also distributes hot meals, hygiene kits, naloxone spray to reverse overdoses and other necessities.
To reach people who are marginalized, “you have to look for them out here to make them feel safe,” said Ciara DeVozza, director of the C3 homeless outreach team on Skid Row for People Concern. “The medical system is not designed like that.”
When her baby was cremated, the LA County woman asked that his ashes be placed in an urn adorned with an angel wrapping a child in its wings.
“I always wanted a baby,” she says. “I’ve always asked God for it, and now I’ve received this gift – and I have to decide how to bring this gift to rest.”