Syphilis is resurging in the U.S., a sign of public health's funding crisis

The country nearly eradicated this treatable sexually transmitted disease twice, only to see it come roaring back. The failure shows the weakness of a cash-strapped public health system.

Transcript

NOEL KING, HOST:

In 1999, federal health officials made a statement about syphilis. It was so rare then that they thought it could be completely eliminated by 2005. Now in 2021, public health workers say they are seeing a disturbing number of babies born with and even dying from syphilis. So what happened? With us now is Caroline Chen. Caroline covers health care for ProPublica, and she's been reporting on this rise in syphilis infections in the U.S. Good morning, Caroline.

CAROLINE CHEN: Hi. Good morning.

KING: So a lot of people hear syphilis, myself included, and think this is a disease that was a problem a long time ago. And yet it is a problem in 2021. What's going on?

CHEN: Yeah, so a lot of people think that this is ancient history. But in fact, it's a sexually transmitted disease that is still going around the U.S. today. Symptoms can be mild, like a rash, but it can also progress and eventually cause blindness or even dementia. Now, if a woman is pregnant, the infection can be passed to the fetus. And unfortunately, without treatment, up to 40% of those pregnancies can end in miscarriage, stillbirth or early infant death.

KING: Syphilis is treatable, though, right?

CHEN: Yes, that's right. It can be cured with penicillin. And during pregnancy, so long as patients are treated within 30 days of delivery, the baby should be fine.

KING: If it's treatable, if it's preventable, if it's a thing we know how to avoid, why are cases going up?

CHEN: Yeah, so STDs are rising across the board in the U.S. And there are a lot of factors at play, like meth use that can lead to risky behaviors like unprotected sex and some patients who don't have access to health care. But also, public health really hasn't had enough resources to stop the spread.

KING: OK, so you've been looking at how some public health departments are responding to this increase in cases. In particular, you've been looking at Fresno County in California. Tell us about Fresno County and what's going on there.

CHEN: So Fresno has had some of the highest rates of congenital syphilis in the state. In 2017, more than 60 babies were born with it. Since then, they've been focused on getting those cases down. I spent some time with my Mai Yang.

MAI YANG: I work at Fresno County Department of Public Health, and my role here is communicable disease specialist.

CHEN: It's her job to track down patients who have tested positive for syphilis, get their partners tested and then get everyone treated. It's kind of similar to contact tracing for COVID cases, but it can be much harder working on cases that involve sexually transmitted diseases because of the stigma. Also, some of Yang's patients are struggling with homelessness or substance abuse.

YANG: There's so many layers to each individual's life. Sometimes, their main concern might just be surviving for the night or wondering what their next meal will be.

CHEN: When I met Yang, she was looking for a 27-year-old pregnant woman named Angelica (ph). She had gone to a clinic in June and tested positive for syphilis. Angelica is homeless. She has no car and no cell phone. And she lives in a tiny rural town where she doesn't have access to prenatal care. Angelica had previously told Yang that she'd go to the clinic for treatment, but she never went. When I joined Yang, she and her colleague Jorge Sevilla were going back to try to reach Angelica again.

COMPUTER-GENERATED VOICE: In a quarter mile, turn right onto the...

CHEN: They found her at a friend's house.

YANG: Hi. Do you remember me?

JORGE SEVILLA: (Speaking Spanish).

YANG: How are you doing?

SEVILLA: (Speaking Spanish).

CHEN: We told Angelica that I'm a journalist, and she said that I could use her story and use her name. Angelica was visibly pregnant, and Yang noticed that she was wearing a wig. You know, hair loss can also be a sign of syphilis. Here's Yang speaking to Angelica. Her colleague is interpreting.

YANG: So the reason why we're coming out here again is because, you know, we really are concerned for the baby's health, especially if she's had this infection for quite a while.

CHEN: Angelica said OK to getting treated, but she wanted to shower first. She told them she'd meet them at the clinic in 15 minutes. So Yang and Sevilla drove over to the clinic, but then Angelica didn't come. They went back to the house. And this time, Angelica had changed, and she got into the car and went with them to the clinic. But then everything fell apart.

YANG: The clinic was a little busy 'cause of COVID. They were doing vaccines. She was told to come back later in the afternoon.

CHEN: And they had to let Angelica go.

YANG: I was a little frustrated to come so close and to be told to come back - was like, oh, you know, like, there's a chance for her to slip away.

CHEN: Unfortunately, this is exactly what happened. Yang has now taken six trips but recently hasn't been able to locate Angelica. I also went myself, but I couldn't find her, either.

KING: Caroline, does anyone know why Angelica won't just go to the clinic where she could get treatment?

CHEN: So Yang told me she hasn't been able to figure out exactly why Angelica is so reluctant to get care. But she pointed out that she doesn't know everything going on in Angelica's life right now. I talked to Dr. Irene Stafford. She is an associate professor and maternal-fetal medicine specialist at the University of Texas in Houston. She sees many patients like Angelica, whose life circumstances can make it hard to get care.

IRENE STAFFORD: I think the hardest part for me is I see them coming back - patients with unstable housing, with intimate partner violence, with substance use, with psychiatric disorders in and out of our ER.

CHEN: And she emphasizes that the fault doesn't lie with these patients. A lot of doctors also aren't prepared to test for or to treat syphilis.

STAFFORD: Providers come up to me and say, really? We have a problem with syphilis? It's devastating to me. It's heartbreaking to me. And I probably get a phone call every other day on, how do we manage a pregnant patient with syphilis?

CHEN: Unfortunately, the stigma of STDs has made it really hard to raise awareness and also to get funding.

KING: But as your reporting shows, this is a nationwide problem, and there is an interesting twist here. When the Biden administration was responding to the pandemic earlier this year, it set aside more than $7 billion to hire and train public health workers over the next five years. That should help, yeah?

CHEN: Yeah, it absolutely will help. And public health departments really welcome the funding. But some people worry that five years isn't enough. Dr. Tom Frieden, a former CDC director, told me that syphilis is a great example of what he calls a deadly cycle of panic and neglect, where emergencies propel officials to throw money at a problem, whether that's Ebola, Zika or COVID-19. But then as fear dies down, so does motivation to finish the task. Public health experts say that this country needs a long-term commitment to public health because, ultimately, if we keep looking away, the bugs will just keep coming back.

KING: Caroline, thanks for sharing your reporting. We appreciate it.

CHEN: Thank you so much.

KING: You can find Caroline Chen's story on NPR and ProPublica's websites.

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