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Syphilis cases in Missouri have jumped 259% in the last few years. Here's what to know

An STD testing kit from myLAB Box allows users to gather samples at home and mail them back to the company.
An STD testing kit from myLAB Box allows users to gather samples at home and mail them back to the company.

Syphilis continues to spread in St. Louis and St. Louis County, according to the latest numbers from Missouri health officials. The increase mirrors a statewide trend — new cases of the sexually transmitted infection more than doubled in Missouri from 2015 to 2021.

The number of syphilis cases in St. Louis and St. Louis County decreased in 2020, but started climbing again in 2021, even as the reported number of other STDS held relatively steady. Between 2019 and 2022, the number of reported syphilis cases increased 42% in both the city and county.

That large local and statewide increases are dramatic, but not surprising, experts said. Earlier this year, The St. Louis and St. Louis County health departments outlined the alarming increases in reported cases in the past seven years, particularly in children who catch syphilis from infected parents during pregnancy. 

An advisory from the Missouri Department of Health and Human Services sent to health care providers noted that cases were increasing across multiple groups — gay, bisexual, and other men who have sex with men, people who use drugs, and heterosexual men and women.

“We’re seeing rapid increases across demographics when it comes to syphilis cases,” said Dr. Hilary Reno, medical director of the St. Louis County STI/HIV Prevention Training Center. “That’s adding up to these marked numbers.”

A stealth STD

Syphilis is a sexually transmitted disease that, when left untreated, can cause severe complications for adults and newborn babies of infected mothers.

Initial symptoms of syphilis include a sore or rash that goes away after a few weeks, even without treatment. But severe health issues may emerge later without proper care with antibiotics, which can cure the disease.

However, many cases go undiagnosed and untreated.

“Once someone actually gets syphilis, they may not know they have it right away,” said Dr. Kanika Cunningham, director of the St. Louis County Department of Health. “So somebody can unfortunately have syphilis for years.”

That can be especially concerning for those who are pregnant. Missouri health officials noted a significant increase in the number of congenital syphilis cases reported to health officials.

Congenital syphilis occurs when a parent passes the untreated infection on to their baby during pregnancy. This type of syphilis may cause miscarriages, premature births, stillbirths, or the death of newborn babies.

Babies born with congenital syphilis often experience serious health complications at birth or throughout life.

What's causing the rapid rise of syphilis?

Overwhelmed health systems and the stresses of the pandemic made things worse, said Ashley Wegner, health planning and policy chief for Clay County, Missouri.

Syphilis cases recorded in Clay County nearly quadrupled from 25 cases in 2015 to 93 last year.
The pandemic also meant fewer people were getting tested, and could have been unknowingly spreading the disease through sex because they didn’t know they were infectious, Cunningham said. 

“We were not identifying those cases like before, because the focus went to the pandemic: testing, treatment, vaccinations,” she said.

Wegner said federal assistance for syphilis testing and treatment has generally fallen short.

In 1999, the U.S. Centers for Disease Control and Prevention requested $35 million to $39 million in federal funds to eliminate syphilis. But the federal government gave the agency less than halfthat. As cases rose and elimination became less feasible, the CDC moved the goalposts to focus on eliminating just congenital syphilis.

From 2015 to 2020, the CDC's budget for preventing STIs increased by 2.2%, but with inflation, that's actually a funding cut of 7.4%.

How to treat — and avoid — syphilis

The best ways to avoid spreading syphilis are to get screened and to avoid unprotected sex, doctors said. Anyone can get syphilis, regardless of their sexual orientation or gender. 

For those especially at risk — men who have sex with men and those ages 15 to 24 — experts recommend wearing a condom and decreasing the number of anonymous sexual partners to reduce the chance of infection.

St. Louis and St. Louis County officials say pregnant people should be tested for syphilis during the first trimester, and then retested at 28 weeks gestation and at delivery if the patient lives in a community with high rates of syphilis, uses drugs or has a sexually transmitted infection during pregnancy. 

At-home tests are available for purchase online or at some pharmacies. The tests typically require a small blood sample from a finger prick. Some more thorough tests may require urine or swab samples.

For those looking for a more cost-effective route to testing, the St Louis and St. Louis County health departments offer free testing for syphilis and other STDS. The city offers testing from 8:30 a.m. to 1 p.m. Monday through Thursday at its "Health Stop" testing center at 1520 Market St.

The St. Louis County Sexual Health Clinic on 4000 Jennings Station Rd. also offers free and confidential STD testing. Manyother low-cost clinics in the region will test for syphilis and other infections. 

To learn more about what the rates of transmission tell us about how these diseases are spreading — and what it will take to get more people tested for STIs — listen to St. Louis on the Air on Apple Podcast, Spotify, Google Podcast, Stitcher, or by clicking the play button below.

Dr. Hilary Reno and Sarah Fentem join St. Louis on the Air

Noah Taborda is the Health Reporter at KCUR in Kansas City, Missouri.
Sarah Fentem is the health reporter at St. Louis Public Radio.
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