There’s a new epidemic on the rise. Syphilis, once thought to be nearly extinct, is rearing its ugly head once again, and this trend started long before the coronavirus.
A Surprising Rebound
2019 marked one of the highest increases in syphilis cases in recent history. In the year 2000, it was considered nearly extinct, at least in the U.S. However, rates started creeping up in 2001 and nearly every year since, spiking 74% in 2015. The Centers of Disease Control and Prevention announced Tuesday that there were 19,000 cases across the country in 2019, marking a 11.2% increase from 2018. The trend has affected all ages and ethnic groups, including both men and women.
Men who have sex with men continue to make up the majority of cases, accounting for 56.7% of all men who contract the disease; however, increases among this group have been slowing in recent years. Syphilis in heterosexual couples continues to increase at a rapid pace, as do the number of cases in women.
According to the CDC, more than a third of women who have the disease in the western U.S. also use meth, which has seen its own rise in popularity over the last few years, especially in rural areas and among the gay community. Meth inhibits a person’s sense of judgement and can lead to risqué behavior.
To compound the issue, popular dating apps like Tinder and Grindr have made contact tracing nearly impossible. People can use this technology to quickly set up a date without knowing the person’s name.
Dr. Ina Park, associate professor at UCSF School of Medicine and author of Strange Bedfellows, which explores the history of STDs, says, “They sometimes only know their online handle. And if the sex didn’t go well, then sometimes they will block the person from their app and they don’t even know how to reach that person again.”
The COVID-19 pandemic is also making things worse. Throughout the crisis, virologists, epidemiologists, and public health officials have been focused on saving lives, which meant treatable conditions like syphilis often went unnoticed.
Dr. Erica Pan, California’s state epidemiologist, says, “We are quite worried about this and have seen this trend over time. Unfortunately, with years of not having enough funding and infrastructure in public health, and then in this past year, of course, both at the local and state level, a lot of personnel who had been focusing on STDs and syphilis follow-up have really been redirected to the pandemic.”
Why Diagnosing the Disease Can Be Difficult
You can cure a case of syphilis with a shot of penicillin, but the disease can lead to blindness, deafness, and even brain damage if left untreated. Patients should start the 10-day antibiotic treatment as soon as possible to avoid permanent damage, but that’s often easier said than done.
Park says many providers aren’t trained to look for syphilis when a patient comes in complaining of fatigue. “The patient came in saying, ‘I’m tired,'” She recounts. “How many people are going to say, ‘Take off your pants and lift up your scrotum, I want to look? We only do that at the STD clinic because that’s what we do.”
Dr. Karen Smith, former director of the California Department of Public Health, says the Affordable Care Act, or Obamacare, actually made the situation worse. The law expanded access to health insurance across the country, so legislators and administrators thought free clinics wouldn’t be in as high demand. But that’s not how things turned out.
“We sort of all assumed that if you’ve got health insurance and you’ve got access to a doctor, that’s all that you need. It turns out that that’s not really all that you need,” Smith remarked.
She says many people would still have affairs, use meth, or engage in unsafe sex practices, but they wouldn’t tell their primary care doctor out of fear or embarrassment.
“That loss of anonymous care really was a problem,” Smith said.
How Syphilis Affects Newborns
The epidemic is affecting soon-to-be-mothers, their children, and pediatricians as well.
Christian Faulkenberry-Miranda, who works as a family pediatrician in Fresno, CA, says she went from treating a couple cases of syphilis a year to two cases every week.
“The disappointing thing is that syphilis is very treatable,” she says. “This is something that’s completely preventable with proper screening and treatment of these moms during pregnancy.”
Mothers that give birth to babies with the disease often have no idea they are infected. Some often lack access to prenatal care. Others may avoid getting tested for STDs if they fear their provider will penalize them for using drugs while pregnant.
“How could this be happening? Testing is cheap and widely available. The same treatment we’ve been using since the ’40s still works,” says Park. “And yet, we have this completely out of control epidemic among the most vulnerable babies in our society.”
Dr. Pan says the pandemic speaks to the importance of investing in contact tracing and community-based healthcare clinics.
“It’s been a really long, hard year responding to this pandemic, but people have really acknowledged and realized the impact of divesting in public health infrastructure,” she said. “I hope that a lot of the resources that we hope to bring to bear in the longer term after this pandemic will benefit STDs as well.”