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New data shows rise in NC syphilis cases, especially in women and newborns


A test for syphilis lies on a patient bed at UNC Campus Health on Monday, April 17, 2023. Syphilis cases are rising in North Carolina, and in 2022, about every six out of 55 congenital cases stemmed from the Orange, Durham, Chatham and Wake County areas.

Last week, the North Carolina Department of Health and Human Services announced that syphilis cases in the state increased by 23 percent from 2021 to 2022.

Syphilis is a sexually transmitted infection caused by a bacteria called treponema pallidum. When passed down from mother to child, the infection is referred to as congenital syphilis. 

Women and newborn babies in North Carolina are especially impacted by the increase in syphilis cases, according to the NCDHHS.

From 2019 to to 2022, cases among women increased by 133 percent. Last year, there were 837 reported cases among women, and this spike has also caused an increase in congenital syphilis. While there was only one reported case of congenital syphilis in 2012, there were 55 reported cases in the state last year — a 31 percent increase from 2021. 

Dr. Arlene Seña, a professor of medicine at the UNC School of Medicine, said the rise of syphilis is an issue not only in North Carolina, but also across the globe. Though she said men have tended to contract the most cases, the number of women infected with syphilis is increasing. 

“So the issue is that women who are pregnant, they're either not coming to care for prenatal care until later, and if they have syphilis, of course, there isn't time for appropriate treatment,” Seña said. 

In its first stages, syphilis can cause swollen lymph nodes, hair loss and other symptoms. It can also cause further diseases like hepatitis and meningitis. 

Pregnant people with syphilis may have a miscarriage or a stillbirth, and some babies with congenital syphilis die shortly after birth. Babies born with this disease may have deformed bones, an enlarged liver or spleen, nervous system problems and other health issues.

Out of the 55 reported cases of congenital syphilis in North Carolina in 2022, six originated in Orange, Chatham, Durham and Wake counties, Seña said. 

“In North Carolina, what we have here is certain women who are at risk for syphilis because they have multiple sexual partners, or they just don't have access to care and then they don't get seen right away,” she said. 

Erika Samoff, the HIV/STD surveillance manager at the North Carolina Division of Public Health, said outbreaks don't need to be scary. She said anyone who is pregnant should expect to be tested for syphilis.

“Syphilis is super treatable,” she said. “It’s not a problem; it doesn't become drug resistant. We just need to be testing for it and treating it.” 

There are several possible reasons for the spike, Samoff said. One is that STI testing was limited during the pandemic, resulting in undiagnosed and untreated cases cropping up now. She also mentioned a lack of health care funding from the federal government. 

“We almost eliminated syphilis in the United States. We got down to one case of congenital syphilis in North Carolina in 2012, but then that funding went away,” she said. “If we actually expand Medicaid, if we pass the budget and the Medicaid expansion goes into place, that will really help us with funding to give people access to testing and treatment.” 

New preventive technologies, such as a drug called pre-exposure prophylaxis (PrEP), have likely led to less condom usage — which Samoff said could be another reason for the spike.

Samoff also said the highest rates of syphilis are among men who have sex with men. She emphasized the importance of everyone having access to health care. 

“If you're a man who has sex with men or a trans woman also, then really good health care for you is your doctor offering to screen you for sexually transmitted infections,” she said. “You should feel like you deserve the best health care you can get and talk to your doctor about that kind of testing.” 

UNC first-year Christopher Wood said he thinks there are many available resources and programs for the LGBTQ+ community on campus, noting that individuals can get a PrEP prescription at UNC Campus Health Services. But he still thinks there should be more sex education for young people, he said. 

“I'm not sure how people without insurance or people without student insurance can get things like STD tests and sexual health care, so things like that I would like to see implemented,"  he said. 


@DTHCityState | 

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