Opinion Columns & Blogs

Syphillis is raging again in Merced, Fresno counties. Yet it can be prevented

It is known as the great imitator. The sexually transmitted infectious disease we know as syphilis can mimic a variety of other illnesses, often making it difficult to diagnose. It can affect a number of body tissues and organs, often has crippling consequences, and (especially in the case of infants) can result in death.

There are three stages of syphilis distinguished by the type of symptoms displayed (or in some case not displayed, there being no symptoms at all). Pregnant women with any untreated stage of syphilis will deliver an infant, or a dead fetus, with congenital syphilis. This can be devastating for the infant and the family.

ken bird.JPG
Merced County public health

Congenital syphilis, or babies born with syphilis because infected mothers were not treated, is completely preventable. Any case of congenital syphilis signals a crisis in public health and the health-care system in the community.

The Central Valley has been impacted more than other regions throughout the state and has experienced a rapid rise in the number of reported cases. In 2012, there were 26 cases of syphilis diagnosed and reported in Fresno County. By 2017, that number had reached 1,561. In 2018, Merced County had 206 cases of diagnosed and reported cases of syphilis. So far, in 2019, 88 total cases have been reported. Merced County did not have any reported cases of congenital syphilis from 2012 to 2017. However, in 2018, there were five reported cases. To date in 2019, there have been two cases reported. More shockingly, the number of cases of congenital syphilis (infants delivered to mothers infected with syphilis) had increased from no confirmed cases to 65 confirmed cases over the same time period. This distressing trend is mirrored in virtually every San Joaquin Valley county.

Fresno County public health

The spike in congenital syphilis cases across the Central Valley began around 2013. Syphilis has always been present in certain populations, but rates of syphilis in all populations began to spread. Once identified, numbers began to grow. State and local interventions reduced the overall rate in total populations. Over the past decade, there have been several cases identified from other forms of risky behavior. This behavior includes unprotected sexual activity among both men and women, engaging in illicit sexual activity for payment in order to support drug habits (which has been steadily increasing over the past several years), and refusing to disclose information on partners who may have been exposed for diagnosis and treatment. Sadly, this infection has had its worst outcomes on babies born to mothers who were infected but did not seek treatment, resulting in a baby born with syphilis, also known as congenital syphilis. All of this makes for a public health nightmare, complicated by frequent re-infection by untreated partners even after appropriate treatment is rendered, increasing numbers of syphilis cases of all stages, and especially increasing numbers of infants with congenital syphilis.

Local public health staff continue to battle against staggering obstacles in an attempt to gain the upper hand on this epidemic. While we continue this effort, our Pillars of Public Health can prevent the spread of the illness into other populations.

As an individual, talk to your health-care provider about risk and testing, and know and practice safe sex. If you are pregnant, make sure you are seeking prenatal treatment and that you have not been exposed to syphilis. If you have, get treated. As a family, have the ongoing discussion about healthy relationships and safe sexual activity, as well as healthy lifestyles that exclude intoxicating substances. As an employer, make access to health-care providers easy and affordable for employees. As a retailer, offer to have public health messages posted in your spaces. As a medical or mental health provider, discuss sexual disease risk and testing with your patients, know the appropriate screening, testing, education, and reporting actions, and make access to care readily available. As an educator, have regular instruction and discussion regarding healthy relationships and safe sexual activity as well as healthy lifestyles that exclude intoxicating substances. As a community and spiritual leader, advocate for healthy relationships, healthy lifestyles, and safe sexual activity. As a public official, focus on upstream policies that are conducive to healthy relationships and safe sexual activity for everyone.

There exists in our community a population with such pervasive shared hopelessness that the default coping mechanism is inexpensive and easily accessed illicit substances. This is what allows an illness such as syphilis to ravage individuals in our community, and it is a dire warning of serious, deep-rooted problems in our community that demand determined system and policy changes.

These include changes that can address the inadequate economic base of our community, changes that can foster excellence and equity in the education of our children, and changes that can empower every single member of our community with the ability to recognize their worth, pursue their passion, and live to their full potential.

No one should suffer the horrific effects of syphilis (especially our infants) when treatment is so readily available.

We must all act now. We are better together.

Dr. Ken Bird is interim health officer for Merced County. Dr. Mercy Kagoda is the Fresno County deputy health officer.