Baltimore’s yearslong struggle with sexually transmitted infections now has a troubling new trend: a sharp rise in the number of babies born with syphilis.

The bacterial disease among the city’s youngest has quadrupled in less than 10 years, spiking to almost four times the national rate.

The often-stigmatized infections are completely curable if caught in time. But left untreated, even for a short time, the outcome can be catastrophic. Newborns who contract infections from their mothers during pregnancy or delivery can develop irreversible problems, such as blindness, deafness and bone deformities — or even die.

Experts say there are a variety of factors at play, including a reluctance by some health care providers to broach the subject in the exam room.

“Providers are incredibly uncomfortable in talking to patients about sex,” said Barbara Wilgus, a Johns Hopkins nurse specializing in sexually transmitted infections who also sees patients in the city. “I know this as a provider and a patient. In all my years going to the doctor, the times I’ve actually been asked about it is so low.”

The outbreak could also become a strain on public coffers. A test for a pregnant woman costs about $8, but care for a child with congenital syphilis can skyrocket. Significantly delaying treatment for an affected child leads to medical costs averaging more than $650,000 per infant, according to an analysis of data from the state’s Medicaid program, which pays for about 40% of all births in Maryland.

City health officials acknowledge the severity of the problem crept up on them, and are now rushing to test and treat more people.

“We went through the pandemic, and our eye was not on congenital syphilis,” said Rebecca Dineen, assistant Baltimore health commissioner for maternal and child health.

Syphilis is a common sexually transmitted infection in adults, with 190,000 cases last year, federal data show. In the earliest stage, it can look like a single sore where the bacteria entered the body. Tracking the infection’s progress then gets tricky, as it develops into a rash and cold-like symptoms for some, or remains largely invisible, with no symptoms, for others. If it is unaddressed for years, syphilis can damage the brain and other vital organs.

While Baltimore‘s rate far surpasses the nation‘s, U.S cases in newborns are also at a record high — nearly 4,000 cases — despite a drop in adult infections, according to 2024 federal data released last month.

By the end of 2023, the city’s rate of congenital syphilis was nearly four times the state and national average of just over 100 for every 100,000 births. (In Baltimore, the infection rate for adults is similarly outsized compared with the rest of the country, clocking in at roughly four times the national rate.)

Dr. Adena Greenbaum, assistant Baltimore health commissioner of clinical services and HIV/STI prevention, described the city’s efforts to bring down syphilis in babies as “a high priority.”

It’s an alarming turn for an infection that was almost eliminated in the 1990s. Officials say infections also are causing a significant number of miscarriages and stillbirths. Public health officials cite a mix of reasons.

Once a major problem only for men who have sex with men, syphilis now infects more women of child-bearing years, a trend exacerbated by the rise in drug use. Experts say that in Baltimore, the infections disproportionately affect lower-income Black women.

Some women tell their doctors that they were unaware of their often-painless infections with no visible symptoms. Other expectant mothers did not receive prenatal care or even routine care that might have flagged an infection.

In other cases, doctors weren’t uniformly performing the blood tests or weren’t understanding or passing on results. And some women were treated only to be reinfected by their partners.

A national shortage of the antibiotic recommended for pregnant women further complicated the response, forcing some providers to spend time scrambling for doses.

In response, city health officials tapped state funding to create a public communications plan designed by the Johns Hopkins Center for Communication Programs to encourage more pregnant women to get tested. The city sent extra staff to three local hospital emergency rooms to educate pregnant women about syphilis and how to get tested. And starting Oct. 13, the city’s sexual health clinic will be moved to Saratoga Street from the city’s North Avenue building that has long been in disrepair.

Dr. Jeanne Sheffield, an infectious disease expert and professor of gynecology and obstetrics in the Johns Hopkins University School of Medicine, said some women may resist testing because they don’t feel sick or don’t think they could be infected. But she recommends universal testing for all mothers throughout their pregnancies so they don’t miss new cases or reinfections, and early use of antibiotics can prevent transmission.

Today across Maryland, health care providers must test the pregnant women they see for syphilis in addition to HIV, according to state law. Syphilis in babies, according to Sheffield, is markedly different from other sexually transmitted infections like gonorrhea or chlamydia because of how serious and irreversible its complications can be.

Wilgus, who also is a program administrator for the STD/HIV Prevention Training Center at Johns Hopkins Bayview Medical Center, said she finds women who make it to a doctor are typically willing to do what it takes for a healthy pregnancy. Often their partners are, too, so a test generally isn’t a big deal.

The bigger challenge, she said, is convincing health providers to discuss sexual health with all of their patients as part of their normal routine. That would likely reduce stigma around STIs and promote more testing for all patients.

City and state officials say they are now working in earnest to reduce infections. The key, according to Dr. Meena Seshamani, Maryland’s health secretary, is making sure patients “can get access to the services they need and that it’s a safe space where they can talk about things that are more sensitive.”