Syphilis up 80% in Hamilton County, highlighting treatment barriers across Ohio

Syphilis cases reached a six-year high in Hamilton County in 2023, according to an April report from the public health department.

At 582 cases, the total represents an 80% increase since 2018, mirroring a national trend that prompted the U.S. Centers for Disease Control and Prevention to declare a national epidemic of syphilis in January.

In Ohio, the increase in syphilis is statewide – but concentrated in major cities.

Cincinnati, Cleveland and Columbus all saw syphilis rates higher than the statewide average for each year between 2018 and 2022, according to data from the Ohio Department of Health.

“There is no definitive answer as to why syphilis diagnoses are increasing,” said Mike Samet, spokesperson for the Hamilton County Department of Public Health.

The doctors that The Enquirer contacted for this story agreed – and cited the lack of easily accessible sexually transmitted infections tests as one reason why the epidemic has been difficult to treat.

Here’s what else they said about syphilis in the Greater Cincinnati area.

Why are cases of syphilis rising? It’s complicated

The rise in syphilis doesn’t mean that people are having more unprotected sex, according to Dr. Carl Fichtenbaum, infectious disease specialist at UC Health and the University of Cincinnati College of Medicine.

“Most of the studies I’ve seen over the past two to three years do not point to any greater incidence of unprotected sex,” said Fichtenbaum. “There’s always been a very steady rate of sex without condoms.”

Dr. Adarsh Krishen, chief medical officer of Planned Parenthood of Greater Ohio, a provider of sexual and reproductive health services, agreed.

Decreased condom use “goes back all the way to the late 70s, early 80s with the AIDS epidemic,” he said.

While the causes behind the epidemic are complex, Krishen hypothesizes that increased substance use may play a role.

“Substance use leads to more risky behavior,” he said.

National data from the CDC shows that deaths caused by alcohol rose by nearly 30% between 2016 and 2020, around the onset of the COVID-19 pandemic.

Syphilis rates may reflect increased STI contact tracing following the pandemic, during which services like STI screening were suspended, but still, “we don’t always know how much testing has been going on," according to Fichtenbaum.

Could rise in syphillis rates reflect a jump in testing?

Fichtenbaum referred to more cases of babies being born with syphilis, also known as congenital syphilis, as “the best barometer” for an epidemic. “That is usually a sign of an uncontrolled syphilis outbreak.”

Congenital syphilis occurs when a pregnant person passes syphilis to their baby and can result in miscarriage, death or long-term medical issues for the infant. Nationally, there were 3,700 babies born with the disease in 2022, 10 times greater than a decade prior.

However, health effects aren’t limited to babies. While syphilis can exhibit no symptoms in its later stages, when left untreated, it can severely damage your heart, brain, eyesight and hearing.

“What we really want to see, of course, is rates falling in a very steady and predictable fashion,” said Fichtenbaum. “That, we’re not seeing.”

STI testing and treatment in Ohio fall short, say doctors, advocates

While the causes of the epidemic are complex, the barriers to testing and treating syphilis are more obvious.

Providers like Planned Parenthood of Greater Ohio, which provided 86,346 STI tests in Ohio last year, have been strained financially since losing state funding from the Ohio Department of Health in 2019. This occurred following a state law defunding entities providing abortion in 2016.

“That did impact our ability to do free STI testing and treatment,” said Lauren Blauvelt, executive director of Planned Parenthood Advocates of Ohio, an affiliate of the nonprofit.

“Now, we really have to try to reserve that free testing for patients who truly are showing up without any kind of way to pay.”

Clinics run by Planned Parenthood may be critical for patients who need care but fear being judged for having a sexually transmitted infection.

“There are some people who feel more comfortable with their physician, but there also are a lot of people who worry about stigma,” said Fichtenbaum. “So people go to health departments; they go to Planned Parenthood.”

When it comes to treatment, however, some people may visit Planned Parenthood out of necessity.

“Most primary providers are not equipped to treat syphilis,” said Fichtenbaum. “It’s much easier to treat chlamydia and gonorrhea, because you can write prescriptions.”

The recommended treatment for syphilis is penicillin, an antibiotic. However, the country has been grappling with a national shortage of the injectable medication since April 2023. Primary care physicians don’t always have penicillin as a result, according to Fichtenbaum.

The Hamilton County Health Department confirmed that the county is still facing a shortage, but that doses of penicillin are available “to be used as necessary” for patients with syphilis.

“We've really not done a very good job with prevention and treatment of sexually transmitted infections,” said Fichtenbaum, pointing to the high cost of care and limited provider hours as barriers to treatment.

“If you’re a working person, working a 7-to-7 job, six days a week, when can you go to a health care provider? When are they open?”

“We just don’t have the best public health infrastructure to really manage this.”

Who was most affected by syphillis in Hamilton County?

• 73% of syphilis patients in Hamilton County were men, according to the county health department.

• 66% of patients were Black.

• 35% fell between the ages of 25 and 34.

• 41% of syphilis cases came from high-risk heterosexual individuals: those who had a prior sexually transmitted infection, had sex while intoxicated or had anonymous sexual partners.

Fichtenbaum stressed the importance of getting tested, even if you’re not experiencing symptoms. For some stages of syphilis, months or even years can pass without any sign of the disease.

“If you’ve been in contact with someone who may have had a sexually transmitted infection, it’s very important that you go get yourself tested,” Fichtenbaum said.

“Sexually transmitted infections are what we call equal opportunity infections," he said. "They occur in everyone.”

This article originally appeared on Cincinnati Enquirer: Syphilis on the rise in Hamilton County and in the US