As U.S. Syphilis Cases Rise, Those at the Epicenter Scramble

Sept. 21, 2023 – It was just a routine checkup – or so she thought. But this time, Marnina Miller’s love interest came along. The pair headed to an STD clinic in Houston, where Miller worked, to get tested for syphilis and HIV. 

With an already compromised immune system due to an HIV diagnosis 9 years ago, it is critical for Miller to ensure she is clear of any other diseases. She tested negative for syphilis. Her partner, on the other hand, tested positive for latent (or stage 3) syphilis. 

Syphilis has been on the rise in the U.S. for more than 2 decades. From 2017 to 2021, the number of cases shot up 75% (to 176, 713), according to the CDC. Houston – the fourth largest city in the U.S. – seems to be at the epicenter. Between 2019 and 2022, there was a 128% rise in syphilis cases there, particularly among women and people of color, according to the Houston Health Department. This summer, drugmaker Pfizer reported a widespread shortage of the antibiotic penicillin, which is used to cure early-stage syphilis and treat latent syphilis. 

“I was immediately scared,” Miller said. “I was nervous about what that meant for me because we did kiss before. And although I am openly living with HIV, there is little education around syphilis and how it is contracted.”

The Houston Health Department has been warning Houstonites to take this public health crisis seriously by practicing safe sex and getting tested if they’re sexually active. There has also been a nine-fold increase in congenital syphilis – which is when a pregnant mother passes the disease to her baby – in Houston and Harris County, TX. To help curb the spread, residents can now get free testing for sexually transmitted diseases (STDs) at Houston health clinics. 

“It is crucial for pregnant women to seek prenatal care and syphilis testing to protect themselves from an infection that could result in the deaths of their babies,” said Marlene McNeese Ward, deputy assistant director of the Houston Health Department’s Bureau of HIV/STI and Viral Hepatitis Prevention. She said a pregnant woman needs to get tested for syphilis three times during her pregnancy.

There are four stages of syphilis: primary, secondary, latent, and tertiary. (See each stage’s symptoms here.) Oral, anal, and vaginal sex are some of the ways the disease can spread. Some people who contract syphilis never have symptoms and could have the disease for years without knowing.

Penicillin can cure both syphilis and congenital syphilis. The antibiotic cannot reverse damage done to your organs via infection, especially if the disease has greatly progressed before treatment. 

Teriya Richmond, MD, explained what an average test day looks like. Upon arriving at the testing site, you will get checked in and learn about the types of STDs you can be tested for. The CDC recommends you get tested for HIV, syphilis, hepatitis C, gonorrhea, and chlamydia. Syphilis tests are done through blood samples. Testing for other diseases include oral or anal swabs, and urine samples, said says Richmond, a board-certified family medicine doctor who specializes in women’s health. 

Sergino Nicolas, MD, creates TikTok videos and Instagram reels to raise awareness about the outbreak. The Pittsburgh-based emergency medical doctor said there is often a “nonchalant” attitude toward STDs among some people in their 20s and 30s. Being unaware of the consequences of syphilis could drive that attitude. “With thoughts like ‘I can just get treated,’ I think there is danger in that, because when you have these infections, [irreversible] complications can occur,” he said.

Preconceived notions among this age group that oral sex is a safer alternative to vaginal or anal sex is also common, Nicolas said. “Any time you might have infected secretions, or be exposed to mucosa, including the vaginal mucosa, that can result in spreading the infection.”

Women of color have been particularly impacted by the outbreak. Syphilis has a wide range of signs and symptoms, and that could play a major role, Nicolas said. Lack of education on the dangers of unprotected sex, particularly if you have multiple sexual partners, could be another reason, as doing so increases your rates of yeast infections and STDs, he said.

Another potential factor: Sexually explicit music and entertainment can also cloud judgment on whether to engage in sexual activity, Nicolas said. Younger generations can especially fall prey to this. “There have been new artists over the past few months that have really been pushing for ‘female empowerment’ in a sense,” he said. “At the same time, they can also push a narrative more so pertaining to promiscuity, which could result in certain psychological effects” that could lead to unsafe sex practices.

Public health activists in Houston are spreading the word on the importance of getting tested for STDs. Kevin Anderson is the founder of the T.R.U.T.H. Project, a Houston-based nonprofit that educates and mobilizes LGBTQ communities of color through social arts that promote sexual, mental, and physical health.

While celebrating its 10th anniversary, T.R.U.T.H. Project is creatively promoting syphilis education and awareness. The organization’s recent events have included an open-mic night called “Heart and Soul,” with free STD testing on site for attendees. It also hosted a sex-positive night aiming to educate attendees about STDs and safe-sex practices. Self-love, self-care, and self-awareness of your body is one of the group’s most prominent messages. “If something feels or looks different, love yourself enough to be proactive in following up to find out what’s going on – because avoidance leads to outbreaks,” Anderson said.

Maybe you’re nervous that you might be STD-positive. Or perhaps you are going to get tested for the first time. Remember that you oversee your sexual health and are in control of your body, Miller said. “Do not be scared. Take care of you.”

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