A mockup of the AIDS Healthcare Foundation’s billboard run in Los Angeles is seen at the AHF offices on May 18, 2018 in Hollywood, California. STDs are making a shocking resurgence across the United States (FREDERIC J. BROWN/AFP via Getty Images)
Colorado public health officials are asking for an additional $8 million to combat syphilis, which continues to spread at a faster rate in the state even as other sexually transmitted infections have begun to slow after increasing early in the pandemic.
The incidence of primary and secondary syphilis cases in Colorado increased by about 18% from 2021 to 2022, roughly three times the 2017 level, according to new data released this week by the Centers for Disease Control and Prevention.
The CDC does not release state-level information on late-detected syphilis cases, but those cases have also increased, said Lacy Mullleavey, prevention and field services program manager for the state health department. In 2022, 165 cases of syphilis were detected in Colorado, with patients suffering serious complications such as nerve damage, hearing loss, or vision loss.
In contrast, gonorrhea infection rates relative to the population are down from their highs in 2021, while chlamydia infection rates are down slightly. Both infection rates are lower than in 2019 but still higher than 2013 levels.
Dr. Ned Calonge, chief medical officer for the state health department, said since testing levels are comparable to pre-pandemic levels, the trend appears to be real and not just a reflection of missed infections.
The situation nationwide is similar to Colorado, with syphilis surging to levels not seen since 1950, while gonorrhea cases are down and chlamydia cases are about the same as the previous year.
The Department of Public Health and Environment is asking the state Legislature for about $2 million per year over four years to fund an opt-out screening pilot program at two hospital emergency rooms in the Denver area and Pueblo County, where syphilis rates have dropped. Very high.
The agency will also provide rapid testing to organizations working with at-risk populations; fund a program to provide treatment in some people’s homes; and build a stockpile of appropriate antibiotics to be shipped to health care providers who have syphilis patients.
While many antibiotics are cheap, bicillin is relatively expensive and in short supply, Mulleavey said. Even though pregnant patients have no other drug options when they need syphilis treatment, many providers won’t keep it on their shelves, she said.
Calonge said the number of people infected with syphilis is far smaller than the number infected with chlamydia or gonorrhea, but its continued rise is concerning because of possible complications, especially for babies born to infected mothers. Syphilis infections among women of childbearing age are growing even faster than the general population, rising 57% in one year after adjusting for population growth.
According to the CDC, 31 babies in Colorado were born with congenital syphilis in 2022, roughly the same number as the 30 cases in 2021 but nearly eight times the number of infections in 2017. Congenital syphilis can cause infant death, skeletal deformities, liver problems, blindness and deafness.
Calonge said preliminary data shows congenital syphilis cases are rising again in 2023.
For a long time, doctors outside sexual health clinics didn’t think to look for syphilis because infections had been declining since the 1940s, Calonge said. But he said the infections happen among people without regular health care, including people who are homeless or incarcerated, allowing the virus to spread.
“In all my years of practice, I’ve never seen a case of congenital syphilis,” he said.
The state has taken some action in the past year to curb syphilis. The state health department and the Pueblo Department of Public Health and Environment launched a small pilot program to treat 16 people, including four pregnant women, at home. However, the $26,000 program only serves women of childbearing age and their affected partners in Pueblo County.
Since July 1, the Pueblo County Jail has screened 182 women for syphilis under a pilot program, according to the state health department. It was found that 37 people were infected, including two who were pregnant at the time. As of December, about 70% of those who tested positive, including two pregnant inmates, had completed treatment.
El Paso and Jefferson counties also began screening female inmates in December but have not yet released data.
Calonge said that while the situation is far from ideal, Colorado is at least doing better than some states because public health agencies can contact anyone who tests positive and provide them with treatment.
“We are fortunate in Colorado, at least for now, that we have the resources to follow up on every case,” he said.
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