Syphilis cases in California have contributed to soaring national caseloads of sexually transmitted diseases. Experts point to the advent of dating apps, decreased condom use and an increase in meth.



The CDC has released new data showing that the number of syphilis cases in newborn babies has almost quadrupled in the past five years. This is a treatable illness. So how did it get so out of hand? April Dembosky of KQED went looking for answers.

APRIL DEMBOSKY, BYLINE: When Christian Faulkenberry-Miranda decided to become a pediatrician, she never thought she'd become an expert in syphilis. In med school, it was nothing more than a test question. Then in her early years on pediatric service in Fresno, Calif., she saw her first case in a newborn.

CHRISTIAN FAULKENBERRY-MIRANDA: Eliana (ph) was very thin.

DEMBOSKY: Her stomach was big and swollen.

FAULKENBERRY-MIRANDA: She had this rash that looks like a blueberry muffin.

DEMBOSKY: This was 2010. Back then, Faulkenberry-Miranda saw a few cases of congenital syphilis every year.

FAULKENBERRY-MIRANDA: And then the numbers just kept increasing.

DEMBOSKY: Now she sees about two cases a week.

FAULKENBERRY-MIRANDA: So it's not going away any time soon, for sure.

DEMBOSKY: The thing is, syphilis is fully treatable. If pregnant women are tested and treated in time, their babies are fine. But if not, babies can go blind, suffer brain damage or die. STD physician Ina Park says the epidemic is out of control.

INA PARK: The test cost less than a dollar. The treatment cost less than a dollar. So it's crazy. It makes no sense that we have let things get this out of hand.

DEMBOSKY: The main reason women aren't being tested and treated is because they're not coming in for prenatal care. Many of them are using methamphetamine and aren't even aware they're pregnant. If they do know, they still don't come in.

KAREN SMITH: There's a real reluctance to seek care because of concern that it's going to be reported.

DEMBOSKY: Dr. Karen Smith was the director of California's department of public health in 2019 when I talked to her. She says women fear they'll get arrested or their children will be taken away.

SMITH: They're very concerned about what's going to happen when they're found to be pregnant and using drugs.

DEMBOSKY: But it's not all on the women. It's the local public health department's job to find these women and get them into care. But in Fresno County, the funding didn't keep pace with transmission.

PARK: There was not enough contact tracers and folks to keep up with the caseloads.

DEMBOSKY: Dr. Park says women need to get treatment at least 30 days before the baby is born for it to work.

PARK: They became so behind on the contact tracing that women were delivering before their case ever got investigated.

DEMBOSKY: Eventually, the state had to step in to help. To be fair, these cases are really complex. Veteran contact tracer Romni Neiman remembers tracking down one woman back in the late '80s.

ROMNI NEIMAN: I ended up going to meet her and talk to her about how she was exposed to syphilis, only to have her burst out into tears.

DEMBOSKY: The woman was basically homeless. Neiman had to talk to her in a stairwell because the woman was afraid the man she was staying with might hurt her if he knew what they were talking about.

NEIMAN: It was really scary. She was absolutely mortified. And she was pregnant.

DEMBOSKY: The woman didn't have a car. So Neiman drove her to get tested. The woman didn't have safe child care. So Neiman held the woman's toddler while she saw the doctor.

NEIMAN: Sometimes it's really taxing and really sad. And you come home at the end of the day, and you're like, wow. Wow.

DEMBOSKY: The coronavirus pandemic has helped show what it takes to combat diseases like this and what happens when we neglect the public health system. People like Neiman hope the renewed interest will last long enough to also help stop the surge of STDs.

For NPR News, I'm April Dembosky in Oakland, Calif.


KING: That story came from NPR's partnership with KQED and Kaiser Health News.

(SOUNDBITE OF GUILTY GHOSTS' "INFINITES") Transcript provided by NPR, Copyright NPR.