‘That really shouldn’t happen.’ Sexually transmitted infections surge in Texas
Sexually transmitted infections are continuing to climb in Texas and throughout the U.S., according to new surveillance data released by the federal government this month.
The spike in sexually transmitted infections also includes a rise in cases of congenital syphilis, in which a mother infected with syphilis transmits the virus during pregnancy. Although congenital syphilis can be prevented by prenatal care, about 2,800 cases of congenital syphilis were reported in 2021, resulting in 220 stillbirths across the U.S., according to the latest data.
In all, syphilis cases increased 32% from 2020 to 2021.
“That really shouldn’t happen,” said Dr. Helen King, an infectious disease specialist at Parkland Health in Dallas. “We know how to prevent congenital syphilis and it is just devastating to think that we’re seeing a rise in cases.”
Texas reported more congenital syphilis cases than any other state in the nation in 2021, with about 680 cases, according to state and federal data. That translates to about 180 cases per 100,000 live births, according to a report from the state health department. Although the total number of congenital syphilis cases is relatively small for a state the size of Texas, experts say that every case of congenital syphilis is a failure, because it is easily preventable and because it can cause such serious consequences for infants.
Left untreated, syphilis can cause miscarriages, stillbirths, and early infant death. For the children that do survive, the disease can still wreak havoc and lead to meningitis and other brain infections, blindness and deafness, liver disease, severe anemia, and more.
There has been a staggering rise in congenital syphilis cases in the state, from 70 in 2016 to 685 in 2021 — an eight-fold increase over six years.
Although congenital syphilis can have some of the most dire consequences for infants, chlamydia and gonorrhea can also be transmitted in utero, and can also affect infants. New cases of chlamydia and gonorrhea increased 4% nationwide. More than 200,000 Texans reported new infections of either chlamydia and gonorrhea in 2021. Chlamydia can also cause pelvic inflammatory disease in the uterus, fallopian tubes and ovaries, and is a leading cause of infertility in women.
In the late 1990s and early 2000s, the U.S. was at the brink of eliminating syphilis entirely. Researchers believe the decline was partly because of the HIV epidemic, which had spurred education about safe sex and led to a corresponding decrease in sexually transmitted infections of all kinds, including syphilis, King said.
The exact reasons that sexually transmitted infections are rising now are unclear, but it’s likely linked to changes in the HIV epidemic, King said. As better treatments for HIV became available, and it became easier to prevent and treat, people might have changed their sexual behaviors.
“We would call these syndemics,” King said. “They’re overlapping epidemics.”
If someone has HIV, they are at increased risk of acquiring a different sexually transmitted infection in part because HIV causes inflammation in the genital tract that can increase the likelihood of acquiring another infection.
To respond to the growing epidemic, King urged people to broach what is sometimes seen as an awkward conversation, and to talk to their doctors about sex.
“We need to empower people in the community to feel comfortable talking to health care providers about sex, to seeking out testing, to talking to their partners about about ways to prevent STIs,” King said.
She urged people to get tested for new infections with their partners and for providers and community organizations to de-stigmatize conversations around sexual health.
The most common STIs, which include trichomoniasis and herpes, are not reported to health agencies, but are similarly increasing across the U.S., King said.
The Texas Department of State Health Services will release its own report on STIs later this year.
