116 3rd St SE
Cedar Rapids, Iowa 52401
Syphilis — close to eradication nationwide two decades ago — now is reaching its highest totals seen “in a generation” across Iowa, state public health officials say.
Preliminary data from the Iowa Department of Public Health shows an increase in the number of sexually transmitted infections in Iowa last year, with the most prominent increases seen in syphilis, which has spiked 55 percent in 2021 compared to the year before.
Most alarmingly, public health officials say there were 11 cases of congenital syphilis in Iowa this past year — more than the past 20 years combined.
“There’s a lot of reasons why we get concerned about syphilis, but the spike that we saw in congenital syphilis last year in the state and from other states is a real cause for alarm,” said George Walton, program manager at the IDPH sexually transmitted disease program.
Congenital syphilis occurs when a mother who is infected with syphilis passes the infection on to her baby during pregnancy. It is a severe and often life-threatening condition for newborns.
By comparison, the previous year with the highest number was 2018 with three cases of congenital syphilis. For a period of time between 2008 and 2013, there were zero cases in Iowa.
New federal data released by the U.S. Centers for Disease Control and Prevention this past week shows this trend has been seen nationwide, with total number of congenital syphilis cases in 2020 spiking 235 percent from 2016.
Congenital syphilis increased 15 percent in 2020 from the previous year, contributing to at least 149 stillbirths and infant deaths that year, CDC officials say.
Iowa did see fatalities among infants with this infection last year, Walton said, but he did not provide a specific total.
CDC officials told reporters this past week that preliminary data — which has not been released yet — indicated the situation continued to worsen into 2021.
Linn County Public Health officials also have noted a “very concerning” increase in congenital syphilis cases locally, mostly among low-income populations or other populations that historically have faced barriers to accessing sexual health services, said Heather Meador, Linn County Public Health clinical services supervisor.
In 2021, total syphilis cases at all stages reached 751 — a 50 percent increase from the 500 cases reported in 2020 and a 108 percent increase from the 360 total cases in 2019.
New cases of syphilis, which is a bacterial infection spread through sexual contact, has increased each year since 2011, according to the state public health department.
There were 70 cases of syphilis a decade ago.
Linn County Public Health investigated 56 cases of syphilis in 2021, Meador said. In 2019, county public health officials investigated 19 cases.
Nationwide, syphilis cases increased 7 percent in 2020, federal health officials stated.
Other STIs increasing overall in recent years
Chlamydia rose nearly 3.5 percent in Iowa in the past year, increasing from 15,095 in 2020 to 15,619 in 2021.
Federal 2020 data shows chlamydia — which historically has made up the largest proportion of STIs in the United States — declined 13 percent from 2019. CDC officials say the drop in cases in 2020 likely is due to decrease in screening rather than a reduction of new infections.
Gonorrhea diagnoses in Iowa, however, did decrease last year. State data shows cases totaled 6,404 last year in 2021, a drop from the 6,919 cases in 2020.
However, 2021 rates still are high above the 2,600 total cases statewide in 2016.
Nationwide, reported cases of gonorrhea increased 10 percent in 2020 from the previous year, according to the CDC.
Both gonorrhea and chlamydia are common sexually transmitted infections that can infect both men and women.
Linn County Public Health, in partnership with the Iowa Department of Public Health, is offering free, confidential STI at-home testing in April. The kits, called Let’s Get Checked, will be mailed to individuals who request them. Beginning in May, the test kits will cost $15.
Individuals interested in receiving a test kit must complete a survey.
If you have questions, contact Linn County Public Health by calling 319-892-6095 or by sending an email to firstname.lastname@example.org.
What’s causing this increase?
Syphilis, along with congenital syphilis, had all but disappeared in Iowa and nationwide by 2000, leading federal health officials to believe they were close to eliminating the infection entirely in the country.
There are a number of factors that could contribute to the increase in infections over the past two decades, but the pandemic had a major exacerbating impact on this trend, Meador said.
Statewide, public health officials saw an overall decline in STI testing, which was in part due to a nationwide shortage of testing supplies, Walton said. In addition, many people put off routine health care — including routine STI screenings — over the past two years, while continuing to engage with new sexual partners.
The biggest increase has been seen among women in recent years, reaching 194 of the total 751 cases in 2021, state data shows. Last year, syphilis diagnoses among women reached 96. In 2011, there were 24.
New cases of syphilis and other STIs also are disproportionately affecting Black and Indigenous Iowans. Walton noted these populations also were disproportionately impacted negatively by certain aftershocks of the pandemic.
“If folks are having a hard time maintaining employment or housing or food, it’s harder to make going to a clinic to do screening a priority,” he said.
Linn County Public Health officials are seeing a large proportion of chlamydia and gonorrhea cases among individuals between the ages of 15 and 24, Meador said, which indicates a need for increased sexual health education in schools and within families.
“That is health,” Meador said. “Your sexual health is as important as your physical health, your mental health, your spiritual health. Anyone who is sexually active should be screened.”
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