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May 26, 2022

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Syphilis cases among infants show concering increase in Pierce County, experts say

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TACOMA — Syphilis cases have risen dramatically among adults in Pierce County and led to an explosion of cases among newborns. It’s a trend seen across the country that has public health experts working to understand what’s causing it and how to stop it.

It’s unknown how much a COVID-changed health care landscape is playing into the increase, but it hasn’t made it easier for those infected to get help.

“In both populations, it’s very concerning that we’re seeing an increase during the COVID era,” said Ericka Case, a Tacoma-Pierce County Health Department communicable disease program manager.

Syphilis is an easily cured sexually-transmitted disease. Left untreated, it’s potentially fatal. Infants born with the bacterial disease inherited from their mothers can face lifelong health complications.

With 2021 adult cases confirmed only through October, numbers might be double in Pierce County in 2021 compared with 2019, according to data from TPCHD:

  • 2019 — 261 cases
  • 2020 — 277 cases
  • 2021 through October — 478 cases

BORN WITH SYPHILIS

Fetuses can get the disease if their mothers are infected and untreated. In Pierce County, what had been an annual average of 1.4 congenital cases for the prior five years jumped to 13 cases in 2021.

The numbers of infected individuals might seem small, but the costs to society can be large, Case said.

“We have newborns that are born with lifelong chronic health issues that will require ongoing support of different health care specialists and the community,” she said.

Infected adults will seek treatment after they notice sores on their genitals, mouth or hands. Often, its cured with a single dose of penicillin, according to Case.

“However, without treatment, it can severely damage the heart, brain and other organs and can be life-threatening,” she said.

Diagnosis in newborns isn’t as easy with adults. They often will have a rash on their palms or soles. Infection can cause stillbirths and infant deaths.

Although TPCHD tracks a variety of sexually transmitted diseases, syphilis seems to be an outlier in its rapid rise, Case said.

When syphilis cases have spiked in the past, it’s usually been in men who have sex with other men. This time, the rapid spread has occurred through heterosexual contact, Case said, which could probably explain the rise in congenital cases.

In Pierce County, there were some demographic patterns in the mothers of the infected infants. The majority of them (age 20-35) were unhoused or in unstable housing situations and used illegal drugs (methamphetamine, heroin) according to TPCHD data.

TRACKING, CURING AND PREVENTING

At TPCHD, investigators identify partners and notify them of a possible exposure to the disease, Case said. Meanwhile, agency epidemiologists are trying to figure out what’s causing the alarming rise in cases.

It’s a trend seen in other counties around Washington and in other states, according to the Centers for Disease Control and Prevention.

Barriers to health care services have increased during the pandemic, Case said. Some people, particularly in unstable housing situations, are finding it more difficult to get medical treatment. Others are avoiding the health care system altogether to reduce their exposure to COVID-19.

Slowing the spread of syphilis depends largely on understanding why it exploded in the past year, particularly among the unhoused population.

TPCHD is devoting more investigators and epidemiologists to people diagnosed with the disease, particularly at encampments.

“That’s what our epidemiologists are really looking into,” Case said. “To look at our cases and really understand them and see what other things might be in existence that are keeping (infected individuals) from accessing care.”

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