Rising Syphilis and STD Cases Strain States as Federal Funds Cut Short

 Rising Syphilis and STD Cases Strain States as Federal Funds Cut Short

Health departments at the state and local levels across the United States are grappling with the sudden loss of the remaining two years of a substantial $1 billion federal investment intended for the treatment and prevention of sexually transmitted diseases (STDs).

The news of this funding cut arrived in June, hitting states hard as they were gearing up to confront the alarming surge in syphilis cases, a trend that was only growing more concerning by the day.

Nevada, for instance, had witnessed a staggering 44% increase in congenital syphilis cases from 2021 to 2022. The state had initially anticipated over $10 million in federal support to bolster its STD prevention program. However, the actual outcome was a crippling reduction of more than 75% in the state's STD prevention budget. This unfortunate situation hampered Nevada's ability to respond effectively to the escalating syphilis cases, as reported by Dawn Cribb from the Nevada Division of Public and Behavioral Health.

The impact of this program's cancellation, linked to the national debt ceiling deal, is most profoundly felt in states' efforts to expand their disease intervention specialist workforce. These specialists play a pivotal role in contact tracing and outreach, critical components in halting the spread of syphilis. Although the United States had reached a low point in syphilis cases in 2000, the disease has been on the rise almost every year since then, with 2021 registering a 31% increase in cases, totaling 176,713.

Sam Burgess, the STD/HIV program director for the Louisiana Department of Health, expressed the widespread sense of devastation, saying, "It was devastating, really, because we had worked so hard to shore up our workforce and also implement new activities." Louisiana was initially expected to receive more than $14 million, but instead, it received $8.6 million, which must be expended by January 2026. The state is now in a scramble to find ways to fill the funding gaps.

While syphilis disproportionately impacts men who have sex with men, the U.S. Centers for Disease Control and Prevention and health officials across the nation have raised concerns about the increasing number of pregnant women transmitting syphilis to their babies. This transmission can lead to severe health issues for infants, including blindness, bone damage, or even stillbirth. In 2021, there were 77.9 cases of congenital syphilis per 100,000 live births.

Disease intervention specialists play a crucial role in connecting infected mothers and their partners with care for syphilis, a disease with mild symptoms in adults, such as fever and sores. Timely intervention can prevent congenital syphilis and help pregnant patients access prenatal care.

Deneshun Graves, a public health investigator with the Houston Health Department, highlighted the emotional challenge of dealing with mothers who were unaware of their syphilis infection, saying, "When you have a mother who didn’t know (she had syphilis), it can be very emotional trying to explain ... it could have been prevented if we could have caught it before."

Lupita Thornton, a public health investigator manager in the health department, expressed her concern about treating pregnant syphilis patients "before 30 days of delivery, for the baby's sake."

The Houston Health Department initiated a "rapid community outreach response" due to a 128% increase in syphilis cases among women from 2019 to 2022, along with congenital syphilis cases surging from 16 in 2019 to 151 in 2021.

The federal grant was anticipated to provide a total of $10.7 million to the STD/HIV bureau, but the department will end up with roughly 75% of that amount.

These funds were instrumental in hiring disease intervention specialists and epidemiologists, essential to the response. However, many health departments had plans to expand further to manage the caseload and reach those in need.

Mississippi is also witnessing an uptick in congenital syphilis cases, which surged tenfold between 2016 and 2022. The shortage of funds and limited access to prenatal care compound their struggles in curbing syphilis transmission.

The Mississippi State Department of Health was originally earmarked to receive over $9 million in federal grant money over five years for expanding its disease intervention workforce. The agency is now challenged to secure resources from other areas of the state's health budget, as per Dr. Dan Edney, the agency's head.

With limited state funding, Mississippi needs to make tough choices, redistributing resources from various programs to bolster diagnostic and treatment rates, and close the loop on investigations.

Arizona faces a significant challenge with the highest rate of congenital syphilis in the nation, at 232.3 cases per 100,000 live births. Federal funds were instrumental in addressing a backlog of non-syphilis STD investigations, which had remained stalled for years at the Arizona Department of Health Services, as stated by Rebecca Scranton, the deputy bureau chief of infectious disease and services. Scranton acknowledged that addressing syphilis would take time and requires preserving some unspent grant money to address future challenges.

Despite these setbacks, health departments remain committed to delivering services and tackling the surging cases of syphilis, highlighting their resilience and creativity in the face of funding cuts. The challenge continues, as the mission to safeguard public health remains unwavering.