St. Louis has the highest rate of syphilis cases per capita of any county in Missouri. In 2022, the year with the latest data available, St. Louis reported nearly 600 cases of the bacterial infection, which is spread through unprotected sex with a person with the disease. Health officials have also seen an increase in syphilis and HIV co-infection and congenital syphilis in newborns.
St. Louis Public Radio's Sarah Fentem asked St. Louis Department of Health Communicable Disease Bureau Chief Suzanne Alexander why rising rates of the disease are so alarming.
Sarah Fentem: I was looking at case numbers of different STDs throughout the state. And chlamydia and gonorrhea are actually much more prevalent than syphilis; they have higher case numbers. Why focus on this particular infection?
Suzanne Alexander: The reason we're so concerned about this is because it can linger in a person and be undetectable by symptoms for any number of years. And it can be transmitted vertically, which means to a pregnant person's unborn, fetus, child, baby.
I wish that we had the bandwidth to address all of it, because we desperately need to. But the big concern about syphilis is congenital syphilis, which is when syphilis is transmitted through a pregnant person and to a child, who is then born with the condition and often born with neurological or physical impacts.
Fentem: Are those cases also rising along with cases in adults?
Alexander: They are. And part of it is because we're noticing that folks are less likely to access prenatal care. And if we catch syphilis, then we can treat it and reverse any of the impacts that babies might suffer from being born with congenital syphilis.
We’d like to see the testing happen with enough time that if the pregnant person is infected with syphilis treatment can be [treated]. It requires three weeks to treat. And if we can get through that three weeks, we have a good chance of the baby being immune to syphilis when born.
[But] we're seeing a lack of prenatal care. And that’s for any number of reasons, most of them socially determined. We have a lot of pregnant people who are unstably housed; we have pregnant people who have been previously involved with the criminal legal system. And we know that we have substance use issues. We know that there's economic opportunity that folks are missing out on, so there's any number of reasons why a pregnant person would not have capacity to follow up on prenatal care.
Fentem: When you look at who's getting sick here in St. Louis, what are you seeing, and are there any patterns?
Alexander: Believe it or not, there's a continuum. You know, folks across [more] age ranges than you traditionally think of, like seniors, are also contracting syphilis.
We’ve seen any number of health systems leave the city and move out to the suburbs. And for folks who do not have ready transportation, or who are working during the times that click clinics are open, it is difficult for them to have that care. And unfortunately, it does impact primarily people of color.
But we have a very densely populated area, meaning we've got more people per square mile. And so that means that resources within the city are kind of limited. I'm sure that you've heard stories about going to the ER and waiting eight to 10 hours if you are not in an emergency situation.
Fentem: And so that leads to the other question. What can the city do to fill those gaps? And what are you doing to fill those gaps?
Alexander: We're trying to work with all of the organizations that provide support to families. We have wonderful partners in the St. Louis County Department of Public Health, we work closely with Washington University, their infectious disease doctors there.
There are several programs that are being designed to provide expanded clinical services. One of them will provide case management to pregnant people with syphilis.
Here in the city, we’re researching best practices to find out what are ways in which other communities have addressed syphilis successfully: Is it a matter of getting the information to the pregnant person? Can we provide support in other ways?
And then we'd really love to talk with people who have experienced pregnancy and syphilis at the same time, people who are currently pregnant, people who are worried about being pregnant and contracting an STI. We'd love to get their stories, because the important thing is to remember, these are not data points. These are people.
The important thing for us to be able to do is to translate evidence based practice into reality. And for me, looking at systems and trying to find ways to provide resources and enable people who are already doing the work, to expand the work that they're doing, seems to be a more efficient way of addressing problems.
Fentem: I saw syphilis rates really pick up around the start of the pandemic. And I'm wondering if there is a connection there. Were public health departments, and communicable disease departments in particular, just so focused on the coronavirus that this was able to kind of boom? Is it just a coincidence? Is it a little bit of both?
Alexander: It's a perfect storm of convergence.
We were doing our best to comply with the restrictions. And we, as a public health agency, did not actually have our screening clinic open. We know that that impacted a lot of community-based organizations that were doing testing for STIs.
One of the things that's been difficult is, as you are probably aware, the public health community of professionals has taken a hit in manpower. As people were becoming more and more frustrated on the outside in the community, we had people who were getting exhausted on the inside. And so we lost people [while] we had a large endeavor to focus on. And we also didn't have a way to provide testing or treatment to individuals who were still having intimate encounters.
Please hug your public health professional today. It's been a long couple of years. And I'm glad that we have the opportunity now to focus on this because it has always been with us.
