State and local health departments across the U.S. were dealt a blow in June when they learned they would lose the remaining two years of a $1 billion investment aimed at strengthening the workforce responsible for tracking and preventing sexually transmitted diseases (STDs), particularly the alarming surge in syphilis cases.
The consequences were immediate: Nevada, for instance, witnessed a staggering 44 percentage-point increase in congenital syphilis cases from 2021 to 2022, but instead of receiving over $10 million to augment its STD program budget, the state saw a reduction of more than 75% in its STD prevention funding. This cut severely hampered the state’s ability to respond effectively to the syphilis crisis, as confirmed by Dawn Cribb from the Nevada Division of Public and Behavioral Health.
A number of states reported to The Associated Press that the cancellation of this program due to the national debt ceiling deal has had the greatest impact on their ability to expand their disease intervention specialist workforce. These specialists play a crucial role in contact tracing and outreach efforts, key components in combating the spread of syphilis. Although syphilis cases in the U.S. hit their lowest point in 2000, the numbers have been steadily increasing every year since then. In 2021 alone, there were 176,713 reported cases, a 31% rise compared to the previous year.
Sam Burgess, the STD/HIV program director for the Louisiana Department of Health, expressed his devastation at the news, stating, “It was devastating, really, because we had worked so hard to shore up our workforce and also implement new activities.” Louisiana was slated to receive over $14 million in funding, but ultimately received only $8.6 million, which must be spent by January 2026. Burgess added, “And we’re still scrambling to try to figure out how we can plug some of those funding gaps.”
While men who have sex with men are disproportionately affected by syphilis, the U.S. Centers for Disease Control and Prevention and health officials nationwide are also concerned about the rise in syphilis cases among pregnant women, who are passing on the infection to their babies. Syphilis can cause serious health complications for infants, such as blindness, bone damage, and stillbirths. In 2021, there were 77.9 cases of congenital syphilis per 100,000 live births.
Disease intervention specialists play a critical role in connecting infected mothers and their partners with syphilis care, as the symptoms for adults are often mild, such as fever and sores. Timely intervention can prevent congenital syphilis, and these specialists also assist pregnant patients in accessing prenatal care.
Deneshun Graves, a public health investigator with the Houston Health Department, described the emotional challenges of explaining to mothers who were unaware of their syphilis infection that it could have been prevented if diagnosed earlier. Lupita Thornton, a public health investigator manager, expressed concerns about treating pregnant syphilis patients before their delivery date, stating, “It can be very emotional trying to explain … it could have been prevented if we could have caught it before.”
In response to the surge in syphilis cases among women, the Houston Health Department launched a “rapid community outreach response”. The number of syphilis cases in women increased by 128% between 2019 and 2022, while congenital syphilis cases rose from 16 to 151 during the same period. The STD/HIV bureau anticipated receiving a total of $10.7 million from the federal grant, but will now only receive approximately 75% of that amount.
While the department has hired disease intervention specialists and epidemiologists with the grant money, Thornton explained that she could use “double of everything,” as her original plan was to hire even more staff in order to decrease the caseload for her investigators. Currently, Graves, for instance, handles over 70 cases at once, a demanding workload.
Mississippi has also witnessed a sharp increase in congenital syphilis cases, with a recently published study revealing a tenfold rise between 2016 and 2022. Health officials attribute this increase to a combination of funding shortages and limited access to prenatal care, which hinders their ability to combat the spread of syphilis effectively.
Dr. Dan Edney, head of the Mississippi State Department of Health, emphasized the challenges they face due to limited state funding and their urgent need to reallocate resources from other health programs in order to increase diagnostic and treatment rates for syphilis. They must also close the loop with investigations.
Arizona currently has the highest rate of congenital syphilis in the country, with 232.3 cases per 100,000 live births. The federal funding has facilitated the Arizona Department of Health Services in clearing a backlog of several thousand non-syphilis STD investigations that had been stalled for years, said Rebecca Scranton, the deputy bureau chief of infectious disease and services.
Scranton acknowledged that addressing the syphilis crisis will take time and stated that they plan to reserve some of the unspent grant money for future challenges. She added, “You don’t know what challenges are going to come. You know they’re going to come, and you just keep getting creative because our job is really to get services to the folks. And that doesn’t change just because you get a funding cut.”
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