By Heather Harrison - Mississippi Free Press
About 900% more babies were born with congenital syphilis in Mississippi in 2021 than just four years earlier in 2017, Centers for Disease Control data shows. The sexually transmitted infection, which syphilis-positive pregnant people can pass onto a fetus, often results in tragic outcomes.
“Syphilis is bad and there’s no doubt about it, but for babies, it’s devastating,” Dr. Thomas Dobbs, who served as Mississippi’s state health officer from 2018 to 2022, told the Mississippi Free Press. “If a baby contracts syphilis in the womb, it’s a 40% chance that baby is going to die, either through miscarriage or stillbirth or death after birth.”
The CDC reported that there were 64 congenital syphilis cases in Mississippi in 2021, up from 37 in 2020 and just two in 2017. Mississippi ranked fourth in the nation for congenital syphilis in 2021, at a rate of 182 per 100,000 live births.
Mississippi had 520 regular non-congenital syphilis cases in 2006, and numbers fluctuated through 2013 when there were 293 cases. But by 2017, there were 937 cases. 2021 data showed 2,605 syphilis cases.
“The problem that we see with syphilis and many STDs (sexually transmitted diseases) is that we often will see fluctuations and increases and decreases that require us to continue to be vigilant, to identify new ways to increase awareness, new ways to do investigations,” Mississippi State Epidemiologist Dr. Paul Byers told the Mississippi Free Press.
The Centers for Disease Control has not released its 2022 sexually transmitted infection reports, so the most updated information regarding STIs is from 2021.
Dobbs, who is now the dean of the John D. Bower School of Population Health at the University of Mississippi Medical Center, explained that the dangers of congenital syphilis include babies developing neurological challenges from the disease or being born prematurely. He mentioned how the STI can go undetected in early pregnancy.
“About a third of women who have syphilis in pregnancy don’t have any prenatal care in the first trimester, so that’s a whole other challenge,” he said.
Treatment is not complicated, however, Dobbs said.
“The sad thing is if you find a mom early in pregnancy and know that she has syphilis, a single shot of penicillin or single treatment of penicillin will cure the mom and the baby,” he said.
‘We’ve Gutted The Public Health Infrastructure
Until this year, Mississippi was one of just six states that did not require syphilis testing during pregnancy. On March 7, 2023, the Mississippi State Department of Health began mandating congenital syphilis testing during the first trimester or first prenatal appointment, during the third trimester and again at birth. Byers said the increasing diagnoses of the STI led to the requirement.
“One of the things that we’ve done to really look more closely at congenital syphilis is now to require testing during the pregnancy, specifically for syphilis,” Dr. Byers said.
The state epidemiologist said the new testing requirement may increase the number of counted congenital syphilis cases.
“We expect that number to grow, … but that’s the goal,” Byers said. “We want to be able to identify additional cases. We want to be able to ensure that appropriate treatment is occurring because, you know, congenital syphilis is preventable; it really is if we can identify those pregnant moms or, in fact, (if) we can get them treated.”
Byers said online dating could be a barrier to STI diagnosis and treatment because of individuals having sex with anonymous or random people. In these instances, it may be more difficult to contact sexual partners who may have been exposed to STIs.
Dobbs said part of the reason syphilis and STI cases are increasing is because the Mississippi Legislature cut public health funding before the COVID-19 pandemic. In 2012, MSDH had 2,358 employees, but by 2020, there were 1,812 employees, Jerry Mitchell reported in an April 10, 2020, Mississippi Center for Investigative Reporting article. MSDH also closed or limited hours at dozens of regional and local clinics across the state in recent years.
“I sincerely believe that a lot of it is because we’ve gutted the public health infrastructure,” Dobbs said. “Back in the 1990s, (MSDH) had 62 people whose only job was to track syphilis and make sure their contacts are treated and people with HIV to make sure that they were, you know, identifying people with HIV. And we have a third of that number now.”
Byers said MSDH is hiring additional investigative employees to meet with and interview people with STIs, identify their sexual partners and use contact tracing to inform people who may have been exposed to an STI so they can get tested and treated.
Mississippi has also seen a significant rise in gonorrhea and chlamydia cases in recent years. Gonorrhea cases increased by 76%—from 7,157 cases in 2017 to 12,617 cases in 2021—making Mississippi first in the nation for gonorrhea rates. The state ranked second for chlamydia cases in 2021 with 22,126 cases, up from third in 2017 with 21,149 cases at a rate of 708 cases per 100,000 residents.
Who’s At Risk?
Dr. Byers said racial disparities are a factor among STI cases in Mississippi and emphasized education, awareness, and access to testing and treatment.
“I think much of it is multifactorial and aligns with many of the racial disparities that we see impacting other diseases,” he said.
Black Mississippians and men who have sex with men have higher numbers of syphilis cases and a greater risk of contracting the STI. In 2021, Mississippi had 155 primary and secondary syphilis cases among gay and bisexual men—the highest in the country at a rate of 898 per 100,000 people.
In 2020, there were 559 syphilis cases among Black individuals in Mississippi, a rate of 50 per 100,000 people, while there were 159 cases among white individuals at a rate of 10 per 100,000.
Dobbs said syphilis could affect Black people and men who have sex with men more due to a lack of access to health care and not being insured.
“We do have a pretty good sense that the sexual behaviors themselves are not depreciably different between white guys and Black guys who have sex with men,” Dobbs said. “It’s just that the risk among their sexual partners is higher because more people have it.”
“For now, heterosexual women are the second highest risk group after men who have sex with men because, as you can imagine, it’s easy for a woman to have syphilis and not know it because it’s an internal lesion,” Dobbs added.
Byers said MSDH has seen “a growing number of increases (in syphilis) in women of childbearing age.”
But STIs can affect anyone, regardless of age, gender, race or socioeconomic status.
“Sexual health is pretty universal. Everybody needs to be checked … and make sure everything is in order,” Dobbs said
Symptoms and Treatment
Syphilis has four stages: primary, secondary, early latent and tertiary. Usually, people will get a painless ulcer on their genitals, mouth or point of sexual contact during the primary phase. The ulcer will heal, but about six weeks later, the secondary phase can cause rashes, fevers, swollen lymph nodes, hair loss and changes to the skin.
The secondary stage’s symptoms may go away or continue to affect an individual. If not treated properly, it can develop into long-term syphilis or neurosyphilis causing brain damage, dementia, paralysis, arthritis or arterial problems.
Doctors use penicillin and doxycycline to cure syphilis. Currently, there is a national shortage of Bicillin L-A, a penicillin used to treat congenital and regular syphilis. Bicillin is the only syphilis-curing drug pregnant people and infants can use.
“What we’re doing now is prioritizing those individuals to receive the doses of Bicillin that we have, and we’re using the other alternative methods until we can get more,” Dr. Byers said.
Prevention, Education, Awareness
The state epidemiologist advised people with “high-risk behavior,” anonymous sex partners, multiple sex partners and those who have had sex with an STI-positive person to get tested and begin treatment if they are infected. He emphasized STI-positive people needing to work with MSDH to identify sex partners.
“We can make an impact,” Byers said. “We need to continue to work at this, and that’s why we’re making the changes that we made.”
To create awareness of STIs, Byers said MSDH is speaking with the media, hosting educational events and communicating with health-care providers and the public. He said the department targets certain communities that have higher STI rates, like Hinds County, to provide additional testing.
“We do have more sophisticated ways now to identify potential hotspots, to bring additional resources to bear, to increase our investigational capacity to identify those cases,” he said.
Byers emphasized the importance of health-care providers reporting accurate data to MSDH.
Dobbs is also the medical director of the Crossroads Clinic in Jackson. He said the clinic has partnered with Faith in Action and faith-based communities and created social media campaigns to educate people about STIs and treatment. The clinic allows patients to walk in on weekdays to get tested and treated for STIs for free or at a low cost.
“Another thing we want to do is create safe spaces for people to get tested,” he said. “Supportive environments, kind, friendly, understanding folks, where people can get care and treatment in a supportive environment.”
Dr. Byers noted that the State has “availability at all county health departments to be able to do testing, and if we identify that an individual is infected, provide the appropriate treatment for them and, depending on the circumstances, for their partner as well.”
For more information on STI testing and treatment, visit the Mississippi Department of Health website at this link.