Why syphilis cases continue to increase in Dallas County — and now across Texas

By Sam Baker

On September 25, 2023

Most cases of syphilis are easily treated with penicillin. Yet, cases of the sexually transmitted disease rose 22% across Texas between 2020 and 2022, and have increased in Dallas County just about every year since 2013.

KERA’s Sam Baker talked about why with Dr. Helen King, an infectious disease specialist with Parkland Hospital and UT Southwestern Medical Center.

We have seen increases in all sexually transmitted infections, gonorrhea, chlamydia, and syphilis. And Dallas has been one of the areas of the country that’s been harder hit than most.

Why?

It’s a bit complicated, why we’re seeing the increases, and not entirely clear, but we do see increases in racial and ethnic minorities. And then we have seen an increase in trends and women as well.

Ethnic and racial minorities. What exactly is the problem there?

The majority of new syphilis cases locally and nationally are in Black and Hispanic individuals. And some of that may be related, especially here in Dallas, to access to care, to information about where to get tested for STIs and different methods of protection.

You’re talking about an awareness problem overall, or maybe a lack of education about it.

It might be cultural barriers to discussing sex, you know, in certain populations, or an acceptance of discussing methods of protection in certain populations.

For women, this sharp increase that we started to see over the past few years may be due to not routinely accessing medical care during the pandemic, or often young people who are otherwise healthy may not seek out medical care on a regular basis, so they may not get routine screening for syphilis.

The big concern of late seems to be a rise in congenital syphilis cases.

Yes, that is certainly the most feared and devastating impact of this current surge that we’re seeing. Congenital syphilis or newborn syphilis can lead to preterm birth. It can lead to miscarriages. It can lead to, you know, devastating developmental complications for newborns.

In Texas, we’ve seen such a sharp increase in the number of newborn syphilis cases and trying very hard to figure out ways to combat that, and most importantly, screening women multiple times during pregnancy for syphilis and treating them as if they’re positive.

Back in 2019, a new state law required health providers to perform additional testing for congenital syphilis. Has that not made a difference at all?

I think it likely has made a difference. The main issue here is we need to catch women early during their pregnancy, to test them early and test them often, and to be sure that we’re preventing this. And so the most important thing is to ensure that we’re capturing women early during their pregnancies and that they’re seeking out prenatal care.

Health officials across Texas have cited a shortage of bicillin?

It’s an intramuscular formulation of penicillin. It really is the mainstay of treatment for syphilis. And it is a critical national shortage of this medication. So we’re been forced to use alternatives.

Such as?

Doxycycline – the main oral and alternative antibiotic to penicillin.

It’s projected this shortage will be resolved, at least in some form, in 2024. We’ve been dealing with this for many months now, but at Parkland where I work, we’ve created an algorithm to preserve those doses (of bicillin) that we do have for pregnant women and infants with syphilis to decrease the impact of newborn syphilis, and then use doxycycline for all other patients.

Unfortunately, antibiotic shortages are not uncommon in this country, but I’m hoping that this one ends quickly so we can really avoid the downstream impact of the shortage, which I do think we will see.

Beyond that what is being done or attempted to bring down cases of syphilis overall?

We’ve really kind of focused on making sexual health care accessible to people in the community. So, you know, if you have a new sexual partner, you know, being able to easily access testing, if you have symptoms, being easily able to easily access care and testing and treatment.

But I really think just getting the message out to the community, especially young people who are more prone to sexually transmitted infections, is imperative.

This piece was republished from KERA News.