The rate of syphilis cases in St. Louis County increased 42 percent between 2016 and 2017, the largest increase in at least five years, according to data released by the county’s health department.
The county saw 202 cases of syphilis last year. That’s up from 142 the year before. Experts attribute the increase to people practicing unsafe sex and not knowing enough about symptoms or treatments for the disease.
According to the Centers for Disease Control and Prevention, the disease was nearly eliminated a decade ago, but it’s reemerged.
“When I was in medical school, we didn’t learn much about it because it was a disease of the past, and we thought it would disappear,” Brad Stoner, medical director of the St. Louis STD/HIV Prevention Training Center. “But in recent years, we have seen a comeback, and we’re now experiencing somewhat of an epidemic.”
Syphilis is treatable and curable, but if left unaddressed, it can cause serious health problems such as blindness and dementia. When a pregnant woman contracts the disease, it is especially dangerous for the developing fetus.
Rates are rising across the United States, but rates of the sexually transmitted disease have been rising faster in St. Louis County. In between 2015 and 2016, for example, the national per capita rate increased 18 percent; in St. Louis County, it increased 41 percent.
Stoner said he sees close to eight men with syphilis for every one woman. Men who have sex with other men are the most at risk, and the disease often shows up alongside HIV cases.
Gains in HIV treatment and prevention could paradoxically be to blame for the increase in syphilis cases, Stoner said.
“They feel protected against HIV, so they’re less likely to use condoms as a result,” Stoner said.
“That has led to a decline in safer sex-prevention practices that leads to a concomitant increase in syphilis,” Stoner said.
Stoner also points to medical authorities’ new shift in philosophy about when HIV is contagious to a change in sexual attitudes. He points to the growing influence of the “U = U” campaign and philosophy, which refers to the phrase “undetectable equals untransmittable,” and means if a person is being treated for HIV and has undetectable symptoms, the virus can’t be spread to a sex partner.
But that maxim doesn’t hold true for syphilis. A person can be positive for the infection but not present any symptoms.
Additionally, geospatial smartphone apps for finding casual hookups make it more difficult for people who test positive to notify former partners of their risk, Stoner said.
The increase alarms St. Louis County Division of Communicable Disease Director Fredrick Echols. But he stands by the prevention efforts of the county. County health workers are seeing more early cases, he said. That means people are more aware of symptoms and are recognizing when they’re infected.
“One of the things we’re definitely seeing in St. Louis County is more cases of primary syphilis, which had been atypical but is a sign that the education efforts we’re embarking on are working,” Echols said. But he said people are still having unsafe sex even when they know they might be infected. That’s the next piece of the puzzle to solve, he said.
“One focus is to really work and engage the community in a more meaningful way, to identify why individuals aren’t changing their sexual behavior,” Echols said.
The health department has enlisted community-advisory groups made up of people who have contracted STDS to “have them at the table and ask: ‘What messages and initiatives would resonate with you the most?’” Echols said.
County health officials plan to continue focusing on preventing transmission and recognizing symptoms. But they also plan to better publicize where to find medical care and treatment, he said.
This isn’t the first time the city has seen an syphilis outbreak, said Stoner, noting St. Louis led the country in syphilis rates in the early '90s. It makes him optimistic it can be handled, he said.
“What worked then is increasing public awareness, a lot of public support. You saw billboards and a lot of concerns for people going out and getting tested and reducing rates,” Stoner said. “I think we could do that again if we had the political will.”
Officials urge every person who is sexually active to get tested for syphilis and other STDs, even if they don’t present symptoms, and to use latex condoms during every sexual encounter.
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