IDAHO, USA — This story originally appeared in The Idaho Press
In the '90s, the U.S. had almost completely eliminated cases of syphilis, a sexually transmitted disease that can be devastating if left untreated.
Today, rates of syphilis in the U.S. are at a 74-year high; rates increased 80% between 2018-2022, according to data published by the Centers for Disease Control in January.
Though Idaho’s incidence rate is lower than the nation, and peaked in 2022, the state continues to see high levels of cases, local public health experts told the Idaho Press. And while additional federal funding was given to states to keep cases in check in 2021, federal leaders decided to rescind it in summer 2023, leaving health districts in Idaho and nationwide to determine how to fund such efforts going forward.
Local public health leaders told the Idaho Press about the rise of the infection in Idaho, and how to prevent its spread.
A ‘SNEAKY’ INFECTION
Syphilis is a sexually transmitted infection, or STI, caused by the bacterium Triponema pallidum. Most prominent symptoms occur in the early stages of the disease, in the first year following exposure, said Jessica McClenahan, a staff epidemiologist with Central District Health, the health district covering Ada, Boise, Elmore, and Valley counties.
Syphilis is transmitted through skin-to-skin contact with an infected person’s chancre, a type of ulcer and early indication of infection.
Other symptoms can include swollen lymph nodes, white patches in the mouth, and a rash on the palms and soles of feet, although McClenahan said people are more frequently reporting the rash on their trunk and extremities instead. The rashes people get are not infectious, she said.
“There are always caveats with syphilis, and we are continually humbled by the sneaky, strange things it does to people,” McClenahan said.
If a pregnant person has syphilis, they are at risk of transmitting the bacteria to the fetus. Symptoms in newborns include deafness and blindness, but babies can be born without symptoms and develop complications later, she said.
Syphilis is treatable with penicillin, but if left untreated, it can enter a latent phase where it stays in the body, sometimes emerging decades later, causing complications like damage to the eyes, ears, and other organs.
But sometimes people skip the latent phase, with the worst complications appearing within the first year, McClenahan said.
In general, people with multiple sexual partners should get full STI testing every six months, including blood work, said Heather Averett, a disease intervention specialist with Southwest District Health.
Using condoms and dental dams during sexual contact helps prevent syphilis’s spread, Averett said.
“If they are consistent in that use, they are protecting themselves,” she said.
McClenahan noted that condom use was popularized in 1500s Europe, not to prevent pregnancies, but to prevent syphilis.
SYPHILIS IN IDAHO
As a disease intervention specialist, Averett spends her day investigating potential cases of syphilis, HIV, and other sexually transmitted infections for Southwest District Health, the health district that encompasses Canyon, Owyhee, Adams, Gem, Payette, and Washington counties.
For Averett, that involves looking at lab results, trying to determine the stage of a person’s syphilis, and referring them and their sexual partners to treatment, she said.
Averett’s position was made possible with increased funding from the Centers for Disease Control to track and prevent the spread of STIs like syphilis.
Health districts had leeway to use the funding as they saw fit, with Central District Health electing to have their disease intervention specialist do educational presentations in schools and juvenile detention centers, said Surabhi Malesha, program manager for communicable diseases with the district.
States have received federal funding for years to fund prevention of sexually transmitted infections, said Lindsay Haskell, a health programs specialist with the Idaho Department of Health and Welfare. In 2021, part of the American Rescue Plan Act directed additional funds toward STI prevention.
In 2020, public health entities were tasked with mitigating the effects of the COVID-19 pandemic, leaving few people to focus on STIs like syphilis, McClenahan said.
Idaho’s health districts are funded by the Idaho Department of Health and Welfare, which is funded entirely with federal money, Haskell said. The infusion of additional federal dollars helped health districts locally and nationally to respond to the rise in syphilis, she said.
Southwest District Health declared an outbreak in Feb. 2021. That year, 43 people had tested positive for syphilis by July, compared to just 18 total in 2017. The district said the outbreak was over in October 2023, as cases dropped to a level that is considered contained, Averett said.
Idaho’s syphilis cases peaked in 2022, with 183 early-stage cases and 169 late or unknown stage cases, according to data from the Idaho Department of Health and Welfare. The following year saw 110 early-stage cases and 98 late or unknown-stage cases.
QUESTIONS OF FUTURE FUNDING
Through the American Rescue Plan Act, Idaho was to receive an additional $5 million in funds to use for STI prevention and mitigation through 2025, Haskell said.
But in 2023, as part of a legislation to address the debt ceiling, the federal government rescinded subsequent funding for the program, according to reporting by the Associated Press. And because published data of STIs lags by a year, public health officials across the country are concerned that case numbers for 2023 could worsen, according to reporting by National Public Radio.
Idaho received $3 million of the $5 million, and has through 2025 to use it, Haskell said. After that time, the health department will have to get creative to decide how it will fund work like Averett’s.
“We’re not sure what that will look like on an ongoing basis,” Haskell said, “and any time we’re using other funding streams, those other projects we had planned may not come to fruition.”
Some of Haskell’s colleagues at the national level are also pushing for additional federal funding to continue supplementing disease intervention programs, she said.
HOPE IN EDUCATION
McClenahan, the epidemiologist with Central District Health, emphasized that getting an STI is “very, very common.” Having an STI does not define someone, nor does it reflect their identity or character, she said.
“The current rates of STIs are more a reflection of lack of access to care and education than some sort of national moral failure,” she said. “We’re hardwired to seek connection and pleasure, and so I think if we bring it to the surface, and talk about it, and normalize sexual health as part of your emotional and physical health, overall, that will make more gains in reducing the STI epidemic.”
Watch more Local News:
See the latest news from around the Treasure Valley and the Gem State in our YouTube playlist:
HERE ARE MORE WAYS TO GET NEWS FROM KTVB:
Download the KTVB News Mobile App
Apple iOS: Click here to download
Google Play: Click here to download
Watch news reports for FREE on YouTube: KTVB YouTube channel
Stream Live for FREE on ROKU: Add the channel from the ROKU store or by searching 'KTVB'.
Stream Live for FREE on FIRE TV: Search ‘KTVB’ and click ‘Get’ to download.
