The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

Preventing Unintended Pregnancies: A Review of Long-Acting Reversible Contraception.

With increasing uncertainty surrounding female reproductive rights, patient education about contraceptive options is of paramount importance. Although traditional oral contraceptive pills (OCP) are often used to prevent pregnancy, they require precise, daily effort and have continual monetary maintenance costs for patients. Long-acting reversible contraceptives (LARCs) - intrauterine devices and the contraceptive implant - are effective and reliable alternatives to OCPs that are gaining popularity in the U.S. These contraceptive options do not require continual patient maintenance and are overall cost-effective. Physicians should be well versed in what contraceptive options are available for their patients and comfortable providing education and recommendations. This analysis will cover what LARCs are on the U.S. market, risks and benefits of each, as well as the CDC's medical eligibility criteria.