Salt Lake County is facing a startling increase in syphilis cases among women, which brings with it an increased risk of syphilis in newborns.
Rates of syphilis have already been increasing across the nation due to varying factors such as decreased public health funding, and may get worse due to recent supply shortages of the antibiotic used to treat it.
Salt Lake County is facing similar trends. Syphilis used to be one of the least common sexually transmitted infections (STIs) in the county, with maybe five cases a year 15 years ago, but this year they've had over 300 cases and are on target to reach at least 400.
According to a recent statement, cases in Salt Lake County rose 65% overall from 2018 to 2022, but cases in women, mostly of childbearing age, have jumped 800%.
This represents a shift in cases, as syphilis is usually most prevalent in groups like “men who have sex with men,” or MSM, a public health term which generally includes cisgender men and transgender women.
Risk of congenital syphilis
This increase also elevates the risk of congenital syphilis, which is syphilis in newborns passed on from the birthing parent. Congenital syphilis can lead to stillbirth, miscarriage or neonatal death, and surviving infants who don’t receive adequate treatment can develop lifelong developmental delays and neurological deficits.
Salt Lake County had its first case of congenital syphilis since 2008 last year, with four confirmed cases so far this year. The U.S. Centers for Disease Control and Prevention (CDC) reported that there were 10 times as many cases in the U.S. in 2022 as a decade ago. The CDC’s report noted that almost 90% of those cases could’ve been prevented with timely testing and treatment during pregnancy.
“A lot of physicians are not being trained on diagnosing, recognizing, and treating syphilis, and it’s often not on their radar to routinely screen for it,” said Lynn Beltran, STD prevention manager with the Salt Lake County Department of Health.
Nearly 40% of nationwide congenital syphilis cases in 2022 were also among mothers who were not in prenatal care, according to the CDC’s report, a trend that Beltran says matches her experience with cases in Salt Lake County.
Barriers to testing and treatment
There are both individual and system-level barriers to timely syphilis testing and treatment, including lack of insurance, systemic racism and unstable housing. Beltran says the stigma surrounding STIs and STDs also plays a large role.
“I think a lot of people like to think oh, it’s those people that will get an STD,” Beltran said. “And I am here to say, I’ve been working with this program for over ten years, and that is absolutely not the case. Anyone that is or has ever been sexually active is at risk for a sexually transmitted infection.”
Lack of normalization can also cause fear, Beltran says, because people don’t understand what they have or how it will affect their lives.
“Finding out that you might have something that’s incurable is really huge,” Beltran said. “And the general population usually doesn’t know which of the STIs are treatable and which ones are not.”
Syphilis is curable with the right antibiotics, but treatment might not undo damage the infection has already caused, which is part of why early detection is vital.
“That fear can certainly weigh on you, but most of the infections that I work with are treatable,” Beltran said. “The earlier you catch them, the less damage has occurred, but it’s never too late. So please reach out.”
Working towards solutions
Salt Lake County has established a task force to work at the state level to combat some of the barriers to testing and treatment. They’re urging health care providers to make syphilis part of routine screening and to screen pregnant patients early on. For patients who test positive on a rapid test, health officials also encourage providers to start syphilis treatment right away while waiting for confirmatory testing.
The Salt Lake County Department of Health is also working with other agencies like Planned Parenthood, Fourth Street Clinic and the Utah AIDS Foundation Legacy Clinic to provide affordable testing for low-income patients and those without insurance.
The CDC recommends screening for syphilis every three months to a year depending on risk factors. The most common symptoms early on are skin issues like sores, rashes and bumps, especially on the genitals, rectum or mouth. For more information on syphilis, visit the CDC’s website.
