Why a spike in Centre County syphilis cases is ‘cause for concern’ and what to know about testing
Centre County had a large increase in early syphilis cases between 2020 and 2021, the Pennsylvania Department of Health recently announced.
In 2020, the county recorded three cases of syphilis and in 2021, 12 cases were recorded — a 300% increase — the DOH wrote in a health advisory. Syphilis is a bacterial infection usually spread by sexual contact. Left untreated, it can severely damage major organs and be life-threatening.
Syphilis hasn’t really been common anywhere, Dr. Casey Pinto of the Department of Public Health Sciences in the College of Medicine at Penn State said. A lot of the funding for syphilis was cut in the 1990s after a big “syphilis campaign,” she said, because the medical community had done well at treatment and contact tracing.
“If you look at the trend for the United States over time, the overall trend in syphilis has been basically creeping up for the past 20 years. And then right before the pandemic hit areas like Washington, D.C., Philadelphia, these big urban settings, were having these huge booms,” Pinto said.
“Then COVID hit and testing stopped, STI clinics shut down. So patients who didn’t have any symptoms weren’t getting screened, and they were able to continue to spread it to new partners that they had, whereas previously, they would have been screened.”
Wes Chicko, practice manager at AIDS Resource Alliance in State College, wrote in an email that regardless of the number of cases, a significant increase in positivity rates is cause for concern.
“Any time you see a significant increase in positivity rates, it’s cause for concern regardless of the actual number. A three hundred percent increase is most definitely something we want to be aware of and attempt to reduce,” Chicko wrote.
The 12 cases reported last year in Centre County could even be an underrepresentation of the actual number, Pinto said. The community is very mobile and if students are being tested, they might be using their permanent address rather than their college housing address.
In addition to the reported 300% increase in syphilis, Centre County also reported an 11% increase in gonorrhea, from 54 cases reported in 2020 to 60 cases in 2021, the advisory stated. Of the 60 gonorrhea cases in 2021, 83% of the cases were reported in individuals under age 30.
The DOH did not respond to a request for 2022 numbers.
Protection, testing & destigmatizing
Syphilis starts as a painless sore typically on the genitals, rectum or mouth, according to Mayo Clinic. It spreads from person to person via skin or mucous membrane contact with these sores.
Chicko wrote that the best way to protect against syphilis is to use condoms. And anyone who is sexually active should also be screened for sexually transmitted infections, Pinto said.
Anyone should be able to request a blood test for syphilis from their primary care provider, or OB/GYN if they’re biologically female, Chicko wrote, and all pregnant women should be tested for syphilis early in their pregnancy. He also suggested using a testing locator tool, https://gettested.cdc.gov, that provides the names of free and low-cost testing centers within a given zip code.
People can get syphilis more than once. Chicko said it’s good for people to familiarize themselves with the symptoms, not only of syphilis, but all STIs.
“The secondary stage of syphilis can sometimes present as a rash on the hands, and so that’s sometimes missed as a symptom of an STI. So being aware of the symptoms can help people monitor their own health and seek testing and treatment early on,” he wrote.
STIs can be asymptomatic, too, Pinto said.
“Often the very first sign that you have syphilis is a painless ulcer. So, it’s a sore where sexual activity occurred. So it might be in the mouth, but you may never notice it because you don’t look in your mouth all the time and it doesn’t cause you any problems, it’s not painful or anything.”
Once someone does notice it, they might plan to get it checked in a week, but by then it has gone away, and since there is no pain, it’s forgotten. But in the asymptomatic phase, they can continue to spread the bacteria to other people, she said.
“Don’t be afraid to get tested. Knowing your status is the most powerful thing you can know,” Pinto said. “If you’re going in for your normal exam, don’t be afraid to tell your provider, ‘Hey, I read this article that said STIs can be asymptomatic. I don’t think I have any but I’d like to just be checked.’ If we normalize it, then more people will get tested.”
Chicko agreed.
“STIs still get stigmatized as something that happens because someone has made poor choices or has poor sexual hygiene. It’s bacteria, nothing more, nothing less. We don’t shame ourselves or other people when we/they get strep (also a bacteria); syphilis shouldn’t be any different.”
