An Increase in Syphilis Gives Arizona Second-Worst Rate in U.S.
Congenital syphilis cases in Arizona increased more than sevenfold from 2016 to 2020. The rise in cases pushed the state from the sixth- to second-worst in the nation in that time.
Arizona’s rise far surpassed the rise in congenital syphilis cases nationally, which increased about 3.5 times from 16.1 cases per 100,000 live births in 2016 to 57.3 in 2020.
In addition, both Arizona and the U.S. saw increases in gonorrhea and syphilis cases. Arizona’s rates for both diseases rose faster and higher. Only chlamydia fell between 2019 and 2020. Although Arizona fell slightly faster than the U.S., its chlamydia rate of 512.3 cases per 100,000 residents was well over the national rate of 481.3.
According to the Centers for Disease Control and Prevention the increase in Arizona leveled off slightly between 2019 and 2020. Experts are not certain if there were in fact fewer cases or just fewer cases were detected since patients had less access to healthcare due to the COVID-19 pandemic.
Recently the CDC released Sexually Transmitted Disease (STD) Surveillance, 2020, a report that details how STDs continued to increase during the first year of the pandemic.
In 2020, the COVID-19 pandemic abruptly interrupted the world. STD program resources were shifted to help control the disease. Many jurisdictions reported critical effects on staffing and testing and treatment supplies, strained the public health infrastructure. COVID-19 significantly affected STD surveillance and prevention efforts, and these challenges are reflected in this new report.
Even in the face of a pandemic, 2.4 million cases of STDs were reported in the U.S. in 2020. The syphilis epidemic continued to surge, driving another year of increases in congenital syphilis. Jurisdictions reported more than 2,100 cases of congenital syphilis, an increase of almost 15 percent since 2019 and a 235 percent increase since 2016. Gonorrhea and primary and secondary (P&S) syphilis cases increased by 10 percent and 7 percent from 2019 to 2020, while reported cases of chlamydia declined 13 percent. However, chlamydial infections are usually asymptomatic and identified through screening. Therefore, this decline is likely due to decreases in STD screening and underdiagnosis during the pandemic, rather than a reduction in new infections. The 2020 STD data also show that some racial and ethnic minority groups, gay and bisexual men, and our nation’s youth continue to experience high rates of STDs.
Focused attention is needed to combat the surge in congenital syphilis, which has dramatically increased in the past five years. In 2020, there were 149 stillbirths and infant deaths, reflecting a startling 210 percent increase since 2016. Data show that 47 states reported at least one case of congenital syphilis is 2020, compared to only 24 states in 2011. The most common missed congenital syphilis opportunity occurred when mothers did not receive timely prenatal care or syphilis testing (41 percent). Fueling this national trend are parallel increases in P&S syphilis (i.e., most infectious phases) among women aged 15-44 years by more than 156 percent from 2016 to 2020. Early 2021 data indicate P&S syphilis and congenital syphilis continued to increase, with congenital syphilis cases already surpassing 2020 counts.
Although 2020 data ultimately point to continued STD increases in the U.S., during the early months of the year – at the start of the COVID-19 pandemic – nationally reported cases of STDs drastically decreased.
Arizona ranked 15th in rates of both gonorrhea and chlamydia in 2020, and sixth for rates of primary and secondary syphilis, which refers to the two earliest stages of the disease.
Several factors contributed to the initial decline in all reported STD cases, as well as the overall drop in reported cases of chlamydia seen at year’s end:
- Reduced screening at healthcare clinics, facility closures, and CDC guidance to prioritize diagnosis and treatment of syphilis and gonorrhea cases;
- Limited resources, including shortages of STD test kits and laboratory supplies, and health department staff shifting to COVID-19 work (affecting STD contact tracing and reporting);
- Enforced stay-at-home orders that may have delayed routine healthcare visits;
- Increased unemployment resulting in a lapse of health insurance coverage for many; and
- Increased use of telemedicine practices to treat symptomatic patients without a confirmed laboratory test result.
COVID-19 continues to impact our healthcare system and STD program resources. It is unclear how the pandemic will affect future STD data. However, there is no reason to believe we will be back to “business as usual” with STD case reporting anytime soon. The key to monitoring congenital syphilis rates is to track primary and secondary syphilis among reproductive-age women before they can pass it on to their child.