Statewide Public Health Order addresses congenital syphilis epidemic

DENVER - In response to persistent and sharp increases in congenital syphilis, the Polis administration is organizing an all-government, comprehensive response to save the lives of babies. The Colorado Department of Public Health and Environment will facilitate coordination between the Behavioral Health Administration, Department of Local Affairs, Department of Health Care Policy and Financing, Department of Human Services, Department of Corrections, Department of Public Safety, and Department of Regulatory Agencies to foster even greater collaboration in response to the growing epidemic.

From 2018 to 2023, congenital syphilis cases increased more than seven times in Colorado (seven cases in 2018 to 50 cases in 2023). So far in 2024, there have been 25 reported congenital syphilis cases, including five stillbirths and two neonatal deaths.

“All expecting parents hope for the same thing — a healthy and happy baby. This statewide, coordinated response will help provide more consistent testing and care for those who are pregnant to help save lives and protect public health,” Governor Polis said.

The Polis administration is directing several state agencies to take swift action, including:

• The Department of Public Health and Environment will assist healthcare and correctional facilities, and laboratories, by providing technical support and staffing for an after-hours line for urgent needs. CDPHE will also continue to meet with providers, public health partners, and other community groups to talk with them about syphilis and congenital syphilis, strategies to reduce cases, and available resources.
• The Department of Corrections (DOC) will ensure those who are pregnant in their care are tested for syphilis upon entry to DOC, as well as in their third trimester and postpartum, through the Denver Reception and Diagnostic Center. 
• The Department of Public Safety (CDPS) will facilitate communication by CDPHE to sheriffs and local governments who operate jails. CDPS is currently working with sheriffs to support testing programs.
• The Division of Insurance will make sure that, in accordance with the Affordable Care Act, testing for syphilis is covered without co-pays for the vast majority of Coloradans with commercial insurance.
• The Department of Human Services will work with healthcare providers to understand this public health order, ensure recommended testing is offered, and educate Coloradans about the importance of testing and treatment for syphilis. 
• Testing will be covered for Coloradans with Medicaid through Health First Colorado, which is administered by the Department of Health Care Policy and Financing. 

Public Health Order 24-01 expands access to syphilis testing during pregnancy. Medical providers must offer testing at greater frequency throughout pregnancy and correctional facilities must provide testing.

“Syphilis was once a rare disease. We are very concerned about this growing epidemic, both in the state and nationally. It is devastating for babies, but there is an effective treatment if caught in utero. The public health order that I am issuing will help us catch more of these cases prior to birth,” said Jill Hunsaker Ryan, executive director, Colorado Department of Public Health and Environment.

According to the CDC, approximately 40% of babies with untreated congenital syphilis may be stillborn or die from the infection.

“This consistent rise in cases spread out throughout Colorado means that we have a statewide congenital syphilis epidemic. The good news is that highly effective treatments exist. We just need to get people in soon enough to save infants’ lives and prevent long-term complications,” said State Epidemiologist Rachel Herlihy.

It is possible to have syphilis and not know it. Untreated syphilis in those who are pregnant can also lead to pregnancy loss, preterm delivery, and permanent medical conditions (blindness, deafness, developmental delays, or bone abnormalities) in babies. Some babies with syphilis can be healthy at birth, but develop life-altering complications later in life.

From 2018 to 2023, cases of syphilis more than tripled in Colorado, increasing from 1,084 cases in 2018 to 3,266 cases in 2023.

“An aggressive and coordinated all-state response is appropriate at this stage of the epidemic,” said Scott Bookman, senior director for Public Health Readiness and Response, CDPHE. “Testing and immediate treatment are available at little or no cost. Our goal now is to get those services to Coloradans who need them as quickly as possible.”

To prevent congenital cases, all healthcare settings and medical providers who care for those who are pregnant must offer syphilis tests:

• In the first trimester of pregnancy (between 1-12 weeks), or at the patient’s initial prenatal visit.
• In the third trimester (between 28-32 weeks).
• At the time of birth.
• If there's a miscarriage after 20 weeks or stillbirth.
• If someone who is pregnant goes to an urgent care center or emergency room, at the intervals and events described above.
• Prisons and jails must also provide these tests. 

Syphilis testing is covered without co-pays for the vast majority of Coloradans with commercial insurance, as well as Coloradans with Medicaid coverage through Health First Colorado. Coloradans without insurance should apply for Health First Colorado - Colorado's Medicaid Program. Free and low-cost testing is available for those who do not have an existing healthcare provider. Coloradans can also order a free at-home test kit.

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