To Do or Not to Do: Chest/Breastfeeding with Syphilis | Breastfeeding Family Friendly Communities

In the face of the United States’ alarming syphilis surge, our community stands at a crucial crossroads. As advocates and providers, the responsibility to navigate the complexities of lactation support amidst this epidemic weighs heavily on us. There is a path forward. In this article, Brandyn Brown-White, a 2^nd year MPH student in the Department of Maternal, Child, and Family Health and UNC Chapel Hill Gillings School of Global Public Health and MRTTI-IBCLC student merges science with compassion to safeguard our most vulnerable.

What Is Syphilis?

According to the Centers for Disease Control and Prevention (CDC), syphilis is a curable, sexually transmitted (bacterial) infection that if not properly treated, may cause severe health complications. This infection is spread through direct contact with a sore during vaginal, anal, or oral sex and developed in four stages – primary, secondary, latent, and tertiary. Syphilis can spread from a pregnant person to their unborn baby, this is known as congenital syphilis. Congenital syphilis can complicate a pregnancy and cause serious issues for both the birthing person and the developing baby. Though this is true, it is typically preventable with early detection and immediate intervention. This can be achieved by receiving regular medical care while pregnant. All North Carolina healthcare providers are required to screen all pregnant people for syphilis at their first prenatal visit, sometimes between 28-30 weeks gestation, and at delivery. If a person does contract syphilis while pregnant, it can be treated with antibiotics that are safe to ingest during pregnancy. If left untreated though, congenital syphilis can lead to premature birth, developmental challenges, and other issues. Such issues may be observed immediately at birth, while others may not present themselves for months or even years. In extreme cases, this condition can lead to infant death and stillbirth.

Syphilis in the United States Today

207,255 total cases of syphilis were reported in 2022. This number marks more than a 17% increase from the previous year and is the most cases reported since 1950. To continue, in 2022, 17.7 primary and secondary syphilis cases were reported per 100,000 people nationally. This is a 9.3% increase since 2021. When considering these statistics, it is important to center equity. While rates of primary and secondary syphilis did rise across most racial/Hispanic ethnic groups, it is important to note that the greatest increase was seen in non-Hispanic American Indian/Alaska Native (AI/AN) persons. Native Americans face higher rates of living in poverty and lower rates of having access to care. This can be attributed to generations of faced inequities that have led to significant barriers to accessing quality healthcare. Native American citizens have the lowest rates of access to preventive health services compared to any other racial/ethnic group. These preventive services often provide care in the form of STI screening and testing, sexual health education, and other techniques to minimize a person’s risk for acquisition of an STI. Inequities like these and others could largely contribute to the AI/AN population holding the highest rates of primary and secondary syphilis in 2022. It is important to consider the multitude of barriers that various racial/ethnic and sociodemographic groups face that may contribute to the rates observed and recorded.

Congenital Syphilis

3,755 cases of congenital syphilis were reported in 2022. About 7.5% of these cases ended in congenital syphilis-related stillbirths and infant deaths. The 2022 congenital syphilis rate of 102.5 per every 100,000 live births, is a 30.6% increase since 2021, and the highest rate documented since 1991. 47 states and the District of Columbia reported at least one case of congenital syphilis, with 39 of those states and the District of Columbia seeing an increase in their rates of congenital syphilis from 2021 to 2022. It is important to consider the multitude of barriers that various racial/ethnic and sociodemographic groups face that may contribute to the rates observed and recorded.

Implications for Families: Feeding and Treatment

Syphilis infection can spread to any part of your breast – including the nipple and areola. Because of this, there can be a lot of trepidation, uncertainty, and nervousness associated with breastfeeding while having syphilis. However, breastfeeding if you have syphilis is still possible. You can breastfeed (or continue to) as long as your baby and/or pumping parts do not touch a sore. If sores are present on your breast (but not necessarily the nipple or areola), the National Institutes of Health recommends pumping and/or hand-expressing the breast with sores until they heal. Doing this helps to maintain your milk supply and prevent painful engorgement due to extreme fullness without emptying. This pumped or expressed milk is safe and can be stored and provided to your baby. If any part of your breast pump contacts sores (like if a sore is present directly on your nipple and/or areola) while pumping though, the resulting milk should be thrown away and is not safe for your baby to consume. Treatment for syphilis while breastfeeding is also safe. Penicillin is the most common treatment for this infection and can be used while breastfeeding as long as you and/or your baby are not allergic to it. Even with this information provided, it is always recommended to check in with and work alongside your physician and child’s pediatrician. This will ensure that a plan for you and your family’s specific needs can be uniquely crafted and discussed for the benefit of everyone’s goals and desires.

Considerations When Informal Milk Sharing

Though breastmilk is regarded as the gold standard compared to formula, when considering informal or community milk sharing it is important to keep in mind that it can be difficult to know for sure that a donor’s milk is 100% safe. When acquiring donor milk from a milk bank, you can trust that all donors are screened, milk is tested, and pasteurization is completed to kill any harmful bacteria or viruses. This substantially reduces risks associated with breastmilk sharing. However, these steps cannot be ensured when going the informal route. It can be hard to know that a donor’s health and lifestyle are safe for the needs of your baby. Viruses and infections can potentially be passed to your baby via breastmilk and result in potentially negative outcomes for your infant. Because of this, when considering peer-to-peer, informal, or community milk sharing, it is important to one, consult your healthcare provider, and two, minimize the risks as best you can.

Minimizing the Risks when Informal Milk Sharing

Get to know your donor: learn about their health and daily lifestyle as much as possible.
Obtain your donor’s blood work: see your donor’s blood test results and ensure they are recent and have been reviewed by a trusted healthcare professional.
Limit the number of donors you use.
Keep in touch with the donor.
Work alongside the donor to ensure the milk you are receiving has been handled, stored, and transported accurately to best ensure the safety of your baby.
Always consult your healthcare provider.