Wagman found that women in these high-risk groups were seeking care, though sometimes late in their pregnancy. They were just more likely to visit an emergency room, urgent care or even a methadone clinic -- places that take drop-ins but don't necessarily routinely test for or treat syphilis.
"These people already have a million barriers," said Jenny Malone, the public health nurse for San Joaquin County. "Now there are more."
The most challenging cases in California are wrapped up with the state's growing housing crisis and a methamphetamine epidemic with few treatment options. Women who are homeless often have unreliable contact information and are unlikely to have a primary care doctor. That makes them tough to track down to give a positive diagnosis, or to follow up on a treatment plan.
Louisiana had the highest rate of congenital syphilis in the country for several years -- until 2018. After a 22% drop in its rate, combined with increases in other states, Louisiana now ranks behind Texas and Nevada. That drop is the direct result of $550 million in temporary supplemental funding that the CDC gave the state to combat the epidemic, said Chaquetta Johnson, deputy director of operations for the state's STD/HIV/hepatitis program. The money helped bolster the state's lagging public health infrastructure. It was used to host two conferences for providers in the hardest-hit areas, hire two case managers and a nurse educator, create a program for in-home treatment and improve data systems to track cases, among other things.
In California, more than 40% of pregnant women with syphilis passed it on to their baby in 2016, the most recent year for which data is available. Gov. Gavin Newsom made additional funding available this year, but it's a "drop in the bucket," said Sergio Morales of Essential Access Health, a nonprofit that focuses on sexual and reproductive health and is working with Kern County on congenital syphilis. "We are seeing the results of years of inaction and a lack of prioritization of STD prevention, and we're now paying the price."
(This KHN story was first published on California Healthline, a service of the California Health Care Foundation. Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.)
(c)2019 Kaiser Health News
Visit Kaiser Health News at www.khn.org
Distributed by Tribune Content Agency, LLC.