Colorado public health officials are asking for an additional $8 million to fight syphilis, which continues to spread more rapidly in the state even as other sexually transmitted infections have started to slow down after an early-pandemic increase.
The rate of syphilis cases caught in the primary and secondary stages in Colorado increased by about 18% from 2021 to 2022, and was roughly triple the 2017 level, according to new data released this week by the Centers for Disease Control and Prevention.
The CDC didn’t release state-level information about cases of syphilis found in the later stages, but those also have increased, said Lacy Mulleavey, prevention and field services program manager at the state health department. In 2022, Colorado found 165 syphilis cases in people who had serious complications, such as neurological damage, hearing loss or vision loss.
In contrast, the rate of gonorrhea infections compared to population dropped from a 2021 high, while the chlamydia infection rate ticked down marginally. Rates of both infections were lower than they were in 2019, though still above 2013 levels.
Since testing levels are comparable to what they were before the pandemic, the trends appear to be real and not just a reflection of missed infections, said Dr. Ned Calonge, chief medical officer at the state health department.
The nationwide picture was similar to Colorado’s, with syphilis spiking to its highest level since 1950 while gonorrhea cases fell and chlamydia remained roughly flat compared to the previous year.
The Department of Public Health and Environment requested about $2 million annually from the state legislature for four years to fund a pilot program for opt-out screening in two hospital emergency departments in the Denver area and Pueblo County, which both have high syphilis rates.
The agency also would offer rapid tests to organizations that work with at-risk populations; fund a program to deliver treatment in some people’s homes; and build up a stockpile of the appropriate antibiotics to ship to providers who have patients with syphilis.
While many antibiotics are cheap, Bicillin is relatively expensive and in short supply, Mulleavey said. Many providers don’t keep it on their shelves, even though pregnant patients don’t have another drug option if they need syphilis treatment, she said.
Far fewer people got syphilis than chlamydia or gonorrhea, but its continued rise is cause for concern because of the potential for complications, especially for infants born to infected mothers, Calonge said. Syphilis infections increased even faster among reproductive-age women than among the general population, rising 57% in one year, after adjusting for population growth.
According to the CDC, 31 babies in Colorado were born with congenital syphilis in 2022 — essentially unchanged from 30 cases in 2021, but almost eight times the number who had it in 2017. Congenital syphilis can cause infant death, bone deformities, liver problems, blindness and deafness.
Preliminary data suggests congenital syphilis cases rose again in 2023, Calonge said.
For a long time, doctors outside of sexual health clinics didn’t think to look for syphilis, because infections had been falling since the 1940s, Calonge said. But the infection happened to land in populations that don’t have regular health care, including people who are homeless or incarcerated, which allowed it to take off, he said.
“I was in practice for a number of years, and I never saw a case of congenital syphilis,” he said.
The state already took some action to try to curb syphilis last year. The state health department and the Pueblo Department of Public Health and Environment run a small pilot program that brought treatment to 16 people, including four who were pregnant, in their homes. The program, which cost $26,000, only serves women of reproductive age and their affected partners in Pueblo County, though.
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Since July 1, the Pueblo County jail screened 182 women for syphilis under the pilot program, according to the state health department. It found 37 who were infected, including two who were pregnant at the time. About 70% of those who tested positive, including both of the pregnant prisoners, had completed treatment as of December.
El Paso and Jefferson counties also started screening female prisoners in December, but haven’t yet released data.
While the situation is far from ideal, Colorado is at least doing better than some states, because public health agencies can reach out to anyone who tests positive and offer them treatment, Calonge said.
“We’re fortunate in Colorado, at least at the current time, that we have resources to follow up on every case,” he said.