Last year, Alaska saw the highest number of syphilis cases ever reported in a single year, part of an outbreak that has been growing for the last three years, according to new data released by the state on Monday.
In 2020, there was a record high of 361 reported cases — a 49% increase from the previous year, according to the latest report. This year is on track to hit similar highs, officials said, noting that the pandemic hindered efforts to control the outbreak.
The state’s syphilis outbreak was first declared in 2018, when 114 cases were reported. The yearly total has increased every year since. In 2019, cases more than doubled, with 242 new cases of the infection.
“We haven’t controlled the syphilis outbreak. The numbers (for 2021) are going to be the same as 2020, if not higher,” Susan Jones, an HIV/STD program manager with the state, said Monday.
Young people, men, minorities and those reporting illicit drug use suffered most from infection, according to the data. Most were residents of Anchorage, Mat-Su, Juneau and Fairbanks, the new report said.
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A record eight cases of congenital syphilis — infections that are passed from a mother to a baby — were reported in 2020. Prior to last year, the most congenital cases reported in a single year in Alaska was two. Most years had one or none, said Jones.
Syphilis is a centuries-old, sexually transmitted bacterial infection that can be deadly if left untreated, but can be easily cured when detected early.
The infection begins as a painless sore on the genitals or mouth. Other early symptoms include a rash on the palms or feet and trouble with vision or hearing. It can attack multiple organs including the heart and brain and can be passed from mothers to unborn children.
Part of the reason for the rise in cases last year may have been that the pandemic complicated treatment and outreach efforts, Jones said. Most public health nurses and other support staff who would have been focused on outbreak control efforts were diverted to helping combat COVID-19, she said.
In addition to being short-staffed, having to conduct contact tracing interviews over the phone rather than in person made it more difficult for people to share their sexual histories with public health workers, Jones said.
“That’s the way to control infection: to find out everyone who’s been exposed, or everyone who has been infected, and get them treated,” Jones said. “If you can’t identify those folks that have been exposed or infected, and don’t know that they have the infection because their name isn’t given to you by somebody who’s been in contact with them, you can’t control the outbreak.”
The reason for the spike in congenital cases was partly that for the last two years, the surge has been driven by cases in heterosexual men and women — a change from 2018 and earlier, when the majority of syphilis cases were recorded in men who have sex with men, Jones said.
If untreated, congenital syphilis is often fatal. It can also cause low birth weight, prematurity and other congenital deformities, according to the World Health Organization.
Congenital cases of the disease can be linked to inadequate prenatal care, Jones said. Mothers are tested for syphilis and other STDs when they show up for their first prenatal care visit.
“But if you never go in for prenatal care, you never get tested,” she said.
Those mothers weren’t tested, or they may have been tested when they went in, but they never had consistent prenatal care, she explained.
Mothers who are treated for syphilis early on in their pregnancy have a relatively low chance of passing the infection to their babies, Jones said.
The syphilis outbreak is part of a larger sexual health problem in Alaska, which has had record high rates of other sexually transmitted diseases like chlamydia and gonorrhea for years.
Syphilis rates are on the rise nationally and have increased almost every year since 2001, according to the federal Centers for Disease Control and Prevention. In 2019, Alaska had the seventh-highest rate of syphilis in the nation, CDC data showed.
There were more than 2.5 million cases of chlamydia, gonorrhea and syphilis in total reported in 2019, according to the most recently compiled data from the CDC. It was the sixth year in a row with record-high counts of STIs reported in the nation.
The most important thing Alaskans can do to keep from contracting and spreading syphilis is to use condoms, get tested regularly, seek prompt treatment and make sure all sexual partners regularly get tested and treated, Jones said.
Planned Parenthood, local public health departments and some local clinics can provide free or sliding-scale testing and treatment, she said.
Testing locations can be found at gettested.cdc.gov.