Public health departments, hospitals and private doctors have seen more cases of syphilis over the past decade.
Since nationwide syphilis case counts reached record lows in the early 2000s, the rates of primary and secondary syphilis increased almost every year in all regions of the country. According to the U.S. Centers for Disease Control and Prevention, between 2020 and 2021, the number of cases increased 28.6%.
Early warning signs led the Kansas City, Missouri health department to launch a campaign to limit spread in 2005 after syphilis cases more than doubled from the year before. But cases continued to rise — the department again sounded the alarm in 2018, after a 71% increase from the previous year.
In all, the number of early syphilis cases reported in Missouri increased by 259% from 2015 to 2021. In Jackson County that amounts to a rate of 39.8 out of 100,000 people – up 15% since 2019 — 19.8 in Cass County, 11.6 in Clay County, and 9.3 in Platte County.
It is a similar story in Kansas, where case numbers have increased from 529 in 2020 to 941 in 2022, according to the Kansas Department of Health and Environment.
Wyandotte County ranks 8th among Kansas counties that report syphilis data to the CDC, with 29.5 cases per 100,000 people — a 450% increase since 2012.
Further down the lists, Johnson County reports 7.4 per 100,000 and Leavenworth 7.1.
What is Syphilis?
Syphilis is a sexually transmitted disease that, when left untreated, can cause severe complications for adults and newborn babies of infected mothers.
The disease is categorized into primary, secondary, early latent, late latent and tertiary stages — and each one presents unique symptoms. Primary syphilis usually presents with a lesion, often called a chancre, but these can be painless and many will not notice them.
The secondary stage often includes a rash across the whole body and new lesions, like sores on the mouth, vagina or anus. But often the rash will go away, leading to early latent and late latent stages, which do not have symptoms.
“I think that's pretty unique and important to know,” said Kristy Herndon, a nurse practitioner at University Health’s Infectious Disease Clinic. “People just assume that their syphilis is gone because they're no longer having symptoms, but it’s not.”
If not treated with antibiotics, eventually the disease will reach the tertiary stage, where symptoms can progress to life-threatening degrees. Often it begins to affect different organs like the brain (confusion, headaches, muscle weakness) or eyes (vision changes, eye pain, sensitivity to light).
Many cases go undiagnosed and untreated, which can be especially concerning for those who are pregnant — the Missouri DHSS noted a significant increase in the number of congenital syphilis cases reported to health officials.
Congenital syphilis occurs when a parent passes the untreated infection on to their baby during pregnancy. This type of syphilis may cause miscarriages, premature births, stillbirths, or the death of newborn babies.
"The standard of care is to test in the first trimester, but it is important to also test in the third trimester, because it can take 90 days for syphilis to show in a blood test," a spokesperson for the Wyandotte County Public Health Department said in an email. "Unfortunately, many healthcare providers do not have comprehensive conversations about sexual health with their patients, and patients may not be comfortable bringing up this topic with their doctor."
Babies born with congenital syphilis often experience serious health complications at birth or throughout life.
Why is it skyrocketing?
Herndon said syphilis cases are likely rising for many reasons. Because symptoms may come and go, often people will not get tested or credit the symptoms to a different cause.
Herndon also noted there is an increased emphasis on syphilis detection.
“We're testing more and so we're finding more,” she said. “So I think we can attribute that to us looking for it as well.”
The pandemic’s effects on mental health and access to certain resources also likely contributed. Matt Shoemaker, an infectious disease expert at the University of Kansas Health System, noted last month that it was harder to access testing and treatment during the pandemic.
Shoemaker also noted changes in sexual behavior — people having multiple sexual partners, letting their guard down about safe sex practices and using illicit drugs — as factors as well.
“Couple that with access to health care, social determinants of health, where people live, those are big factors,” Shoemaker said. “Do they have transportation? Do they have housing? Do they have food insecurity?”
Last year, Ashley Wegner, the health policy and planning chief for Clay County, told KCUR a trifecta of poor mental health, substance use and increased risky sexual behavior is “the perfect storm” for an increase in overall infection rates.
Federal assistance for syphilis testing and treatment has generally fallen short.
In 1999, the U.S. Centers for Disease Control and Prevention requested $35 million to $39 million in federal funds to eliminate syphilis. But the federal government gave the agency less thanhalf that. As cases rose, the CDC moved the goalposts to focus on eliminating just congenital syphilis.
From 2015 to 2020, the CDC's budget for preventing STIs increased by 2.2%, but with inflation, that's actually a funding cut of 7.4%.
How can people avoid and treat syphilis?
Shoemaker said one of the most concerning pieces of information to him was that 40% of cases of congenital syphilis did not have access to prenatal care.
Syphilis is a very curable disease and one of the few bacteria that have not developed drug resistance over the past 70 years. Penicillin was, and still is, the gold standard for treatment.
Unfortunately, the increase in cases has also led to a shortage of penicillin. But Shoemaker said this is something hospitals have planned for.
“We’ve triaged how we would use penicillin,” he said. “We’ve made sure with our recommendations that pregnant women are at the top of the list because the risk of congenital syphilis and the outcomes are so devastating.”
Shoemaker said some alternative antibiotic treatments work, but are not used for pregnant women.
KDHE recommends three screenings for syphilis during pregnancy – at a patient’s first prenatal visit, at 28 weeks and at or just before delivery.
While state and local health departments have limited funding for syphilis testing, Kansas City, Missouri and Jackson, Clay and Wyandotte counties offer some free testing. Clay has a clinic that offers treatment to those without insurance.
Wyandotte County's health department provides pregnancy testing, and if a person is pregnant, the department will also test them for HIV and syphilis.
