Iowa’s syphilis cases increase, but other STIs on the decline

An ancient but treatable sexually transmitted disease is seeing a resurgence in Iowa.

The state counted 877 new cases of syphilis in 2022 — a 209% increase compared with the 283 cases in 2018, according to new data from the Iowa Department of Health and Human Services.

Syphilis case counts have increased nearly every year since 2011, with last year’s new total significantly higher than the 70 cases reported a little over a decade ago. There were 751 cases in 2021, and 500 cases in 2020.

At the same time, state data indicates new cases of gonorrhea and chlamydia, which are other types of sexually transmitted infections, declined in 2022. The state is also on the leading edge of addressing HIV rates in Iowa.

There’s no clear indication why syphilis, a type of bacterial infection that’s typically spread through sexual contact, is trending on an opposite path from other sexually transmitted infections, public health officials say.

However, it is clear that rising rates of syphilis are also driving an increase in congenital syphilis, a virus that was virtually nonexistent in Iowa two decades ago, said Dr. Robert Kruse, the state medical director and division director of public health at Iowa HHS.

In 2022, the state reported eight cases of congenital syphilis, which occurs when a mother who is infected with syphilis passes the infection on to her baby during pregnancy. Infection is severe and can be life-threatening to newborns.

In 2021, the state counted 11 congenital syphilis infections in young children — a total that was more than the preceding 20 years combined, Kruse said. By comparison, Iowa had just one case in 2000.

What’s driving the increase in syphilis?

Public health officials say the virus is affecting virtually all demographics, including individuals of all ages, races and socio-economic status.

Syphilis is typically present in men who have sex with men, but in recent years, it has become more prevalent in other populations, including women, Kruse said.

In 2020, 12% of infectious syphilis diagnoses in Iowa were among women. In 2022, that rose to 34%, he said.

“We know that it’s going to fuel some of the congenital syphilis cases that we’re seeing as well,” Kruse said.

Public health officials say the pandemic, which interrupted routine health care for many individuals, likely meant many people weren’t seeking routine testing for sexually transmitted infections.

In addition, symptoms for syphilis are not as obvious as other sexually transmitted infections. In the earlier stages of the infection, individuals can develop sores and later a rash that often goes away on its own, Kruse said. These symptoms are typically mild and painless.

“Because the symptoms are mild, that can be mistaken for other things,” said Melissa Brown, public health investigator at the Polk County Health Department. “People don’t notice them as an STI and maybe are not talking with their providers about that. So that’s why we really encourage routine testing for everyone.”

Syphilis can be treated with antibiotics. So far, Iowa is not facing shortages in medication to treat this condition that other states are facing, Kruse said.

In Polk County, 877 new syphilis cases at all stages were detected, an increase from 751 cases in 2021 and 500 cases in 2020, public health data shows. That’s compared to the 283 cases in 2018.

In light of the recent years’ increase in cases, Polk County Health Department has increased staffing to better investigate these infections and notify potential partners who were exposed, Brown, said.

While the Polk County saw an increase in overall syphilis cases last year, the number of individuals in the earlier, more infectious stages of the infection did decline in 2022. This is a good sign, Brown said, because individuals in the later stages of the infection are less likely to transmit it to others.

“Those early infectious cases are the ones that we’re most concerned about spreading it to other people,” Brown said. “So its great to see that decrease, but we are still seeing a lot of syphilis overall that may have had it longer than a year and just not diagnosed.”

Syphilis rates have also increased nationwide every year since 2000, when the United States reached a “historic low” in case counts, according to new data from the U.S. Centers for Disease Control and Prevention. In fact, cases were so low that some public health officials believed they were close to eradication of the infection.

Federal public health officials counted 176,713 syphilis cases, which includes all stages of the infection, in 2021, an increase from the 133,954 cases in 2020. Federal officials say the latest total is the highest since 1950, when the country reported 217,558 cases.

The report also found that cases of congenital syphilis, which occurs when a baby is born with the infection after the mother passed it on during pregnancy, rose by 32% from 2,148 to more than 2,800. This resulted in 220 stillbirths and infant deaths in 2021, the agency said.

Iowa leads nation in HIV viral suppression

But while state and local public health officials work to address the recent spike in syphilis and congenital syphilis statewide, they say other sexually transmitted infections have been falling statewide.

In fact, Iowa was named the top state in the nation for suppressing HIV in diagnosed patients in 2021, according to a new report from the CDC. In Iowa, 81.7% of people with HIV achieved viral suppression, which means they cannot transmit the virus to others. Those who achieve viral suppression also have better health outcomes, according to state public health officials.

By comparison, the CDC report shows the national average for viral suppression was 65.9%.

Federal health data also shows 88.1% of Iowans living with HIV received medical care in 2021, and was among the top ten states for usage of PrEP, or pre-exposure prophylaxis that reduces an individual’s chance of getting HIV.

State public health officials largely attribute this success to its partnerships with community providers who are working to address disparities in health care access.

Other STIs on the decline

New cases of gonorrhea and chlamydia, two other well-known types of sexually transmitted infections tracked by the state, have also been on the decline after recent years of major spikes, new state public health data shows.

The state counted 4,466 cases of gonorrhea in 2022, a decrease from the 6,404 cases reported the previous year.

In 2020, Iowa reported 6,919 cases of gonorrhea, an increase from the 2,600 reported in 2016. That’s also a 370% compared to the 1,471 cases in 2013, the lowest case count recorded in the past decade.

For 2022, the state reported 14,633 new cases of chlamydia. Case counts have fallen from the 15,619 cases in 2021 and 15,095 cases in 2020.

New cases of chlamydia had also seen large increases since 2013, rising from 11,006 cases that year to 16,046 in 2019.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at [email protected], at (319) 339-7354 or on Twitter at @Michaela_Ramm