With national syphilis case counts on the rise, Kentucky’s top health official hopes the state can combat climbing rates of the disease in adults and newborns with more testing and education efforts.
The Centers for Disease Control and Prevention shared data in November that indicated more than 3,700 newborn children born in 2022 were diagnosed with congenital syphilis, a disease that occurs when a pregnant person with syphilis passes the infection to their baby during pregnancy. That’s more than ten times higher than 2012’s case count. This increase comes alongside the rising number of syphilis cases among the child-bearing population in the United States.
Kentucky ranks 30th in the nation when it comes to syphilis case rates, according to CDC data published in 2021.
Residents of the Bluegrass State tested positively for the disease at a rate of 11.4 per 100,000 people – with just north of 500 cases that year diagnosed in the Commonwealth. The same data set indicated thatthe Kentucky counties with the highest syphilis rates are Estill, Clay and Lee.
Syphilis rates have increased over time in Kentucky. In 2004, only 47 cases of primary and secondary syphilis and just one case of congenital syphilis were reported. The rate of congenital syphilis in Kentucky at the time was just 1.8 cases per every 100,000 thousand people, now that rate stands at 47.9.
Dr. Steven Stack – the commissioner of Kentucky’s Department of Public Health – said he hopes that more awareness of the disease is key.
“These are not the things that we typically talk about around the kitchen table, you know, syphilis in the community, but things like this are very, very important. [We are] trying to find a way to reduce as quickly as possible the number of children and newborns who experience congenital syphilis,” Stack said. “Ultimately, we need to be able to treat [syphilis] in the entire population and try to turn this situation around.”
Stack said the first step to tackling the issue of syphilis is to increase testing among at-risk populations – including sexually active adults, those looking to become pregnant and those already with children. He also said that testing practices in the state are being updated to be more proactive in catching the disease before it’s too late.
“Recommendations have shifted,” Stack said. “Pregnant women are recommended to be tested three times related to their pregnancy – in the first trimester, third trimester and then actually at the time of delivery.”
Stack, who worked in emergency medicine for nearly two decades, said that for many years doctors in Kentucky and around the country did not routinely test for syphilis, and now the country is facing the consequences.
“You didn't routinely test for it,” he said. “Now I think we need to routinely test for syphilis whenever we test for [gonorrhea, chlamydia and trichomonas] because it’s now shown it's becoming more common.”
The CDC said in a 2023 report that the climb of congenital syphilis rates in the country reflects “a failure of the U.S. health system,” connecting the rise with people testing too late and treating the disease improperly during pregnancy, individual barriers like substance use disorder or a lack of insurance, systemic racism, limited healthcare access, medication shortages and a lack of prenatal care.
Stack said that barriers to increased testing include stigmas around STDs – which he said could lead individuals to feel unnecessary shame or embarrassment about seeking screenings. That’s something the Kentucky public health commissioner wants to fight against.
“We need to make sure people are comfortable and know that when they seek health care… their care is confidential,” he said.
Processing turnarounds on tests can also create issues. Tests for syphilis don’t come back immediately and – by the time the results are reported – it may be too late for some.
“This was an experience I was all too familiar with in the emergency department,” Stack said. “People coming into the ER for conditions like sexually transmitted diseases … didn't always give accurate contact information for telephone numbers or addresses so we couldn't reach them.”
While some medical manufacturers have developed rapid tests for the disease, Stack said those come with their “own limitations and trade offs”.
Stack said the most important step people can take in preventing the spread of syphilis is practicing safe sex. He said condoms can dramatically lower the chances of transmitting all STDs, not just syphilis.
“It's important that we make sure people are familiar about the risk, that people share information with each other and that we look out for each other,” Stack said. “We [need to] make sure that people have access to testing and treatment and they can find these diseases and get them treated quickly so that nobody suffers needlessly.”
