PRO/EDR> Syphilis – USA (12): (MS) increase, 2022, RFI


A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 15 Jun 2023
Source: Hattiesburg American [abridged, edited]

Former state health officer Dr Thomas Dobbs recently sent out a tweet
saying Forrest County’s rate of syphilis cases is 3 times higher than
Hinds County. Dobbs, who resigned from his position in July 2022 as
the coronavirus pandemic appeared to be on a decline, said Forrest
County — and the Pine Belt region — is a “hotbed of syphilis in
Mississippi”. “Docs and providers — think about syphilis in your
patients,” he wrote.

From the data Dobbs shared on Twitter, Forrest County had the second
highest rate in Mississippi for number of cases of primary and
secondary syphilis per 100 000 people in 2021, the most recent figures
available. Only nearby Covington County’s rate was higher. In 2020,
Forrest County again had the second highest rate, [yielding only] to
Coahoma County in the Delta.

But what does that mean? The Mississippi State Department of Health
helps explain what syphilis really looks like across Mississippi.

The most recent report provided by the Centers for Disease Control and
Prevention that was available to review was from 2021. The figures for
that year and 2020 come with a warning that the data may not paint an
accurate picture. One reason given by CDC was the disruption of
STI-related prevention and care services that started in 2020 with the
surge of COVID-19 cases. The lack of available services likely
continued into 2021, CDC reported.

The 2021 rate for Forrest County was 109.1 cases per 100 000 people,
just under Covington County’s 109.4. Hinds County’s rate in comparison
was 36.4 — like Dobbs said, about 1/3 of Forrest County’s case rate.
Forrest County’s 2020 syphilis rate per 100 000 people was 94.8.
Coahoma County, in the Delta, was 94.9. In contrast, Hinds County’s
rate was 34.5 cases per 100 000 for the year 2020.

Looking at the actual numbers of cases reported, Hinds County had a
total of 80 cases reported in 2020, compared to Forrest County’s 71.
Coahoma County reported 21 cases in the same year [2020]. Forrest
County cases took a leap in 2021, reporting 85 cases to Hinds County’s
81 — the 1st and 2nd-highest number of cases that year. Covington
County reported 20 cases in 2021.

What makes the difference in the rate vs. number of cases is the
population of each county. Hinds County had around 230 000 residents
in 2020 and 2021, while Forrest County reported approximately 75 000
residents during the same period. Coahoma County recorded just over 22
000 residents in 2020. Covington County’s population in 2021 was about
18 300.

Despite possible anomalies in the reporting of syphilis cases during
the pandemic, it is likely the upward trend will continue, state
epidemiologist Dr Paul Byers said in an email, but that trend is not
just limited to Mississippi. That trend is expected to continue, he
said. In fact, the increase in syphilis cases in Mississippi began
before the pandemic, leading the nation. “The increases in syphilis
are being seen across Mississippi and are really seen nationally as
well,” he said. “The increases are likely multifactorial, and include
better identification and reporting of cases.”

In addition to better documentation of syphilis cases, social factors
could be the cause of the rise in not only syphilis but other sexually
transmitted infections — like gonorrhea and chlamydia — as well.

“It is important to consider the impact of the growth of illicit drugs
as well as increased use of anonymous online dating services which can
lead to difficulties identifying contacts to test/treat,” Byers said.
Byers, who announced he will retire at the end of June, did not
specifically address why cases were going up in Forrest County or why
cases in Hinds County are decreasing. Attempts to reach other medical
professionals for comment were unsuccessful.

Byers said much is being done at the state level to fight the
continued rise of STI cases in Mississippi. “Maintaining public health
infrastructure is important, and MSDH continues to prioritize
increased staffing, increasing provider communication and support, and
modifying testing requirements to limit the impact,” he said.

One of the new requirements is the addition of syphilis testing during
pregnancy. Pregnant women should be tested for syphilis in the first
and third trimesters and again at delivery, Byers said. “Congenital
syphilis can be prevented with appropriate testing and treatment,” he
said. “If you are pregnant, make sure you are tested. If you test
positive while pregnant, make sure you are treated appropriately with
penicillin.” If left untreated, congenital syphilis can lead to
long-term health problems in the child or may cause preterm birth or

“We are doubling down on our efforts to ensure that positive pregnant
women are identified, reported to MSDH, and treated,” Byers said. “We
are working with our partners to ensure providers are aware and
understand the new testing and reporting requirements. Testing and
reporting by providers is key.”

Nationwide, syphilis cases increased by about 30% in 2020 and 2021.
Nearly 1/2 of the cases reported are in men who have male sexual
partners, CDC reported. But the number of female cases is rising
sharply, having increased 55.3% in 2020-21 — 217.4% from 2017 to

It is important to note that these disparities are unlikely explained
by differences in sexual behavior and rather reflect differential
access to quality sexual healthcare, as well as differences in sexual
network characteristics. For example, in communities with a higher
prevalence of STDs, with each sexual encounter, people face a greater
chance of encountering an infected partner than those in lower
prevalence settings do, regardless of similar sexual behavior
patterns. Acknowledging inequities in STD rates is a critical first
step toward empowering affected groups and the public health
community, to collaborate in addressing systemic inequities in the
burden of disease — with the ultimate goal of minimizing the health
impacts of STDs on individuals and populations.

More than half the cases reported in 2021 were in teens and young
adults, 15 to 24.

[byline: Lici Beveridge]

This site uses Akismet to reduce spam. Learn how your comment data is processed.