Syphilis: A sore pitfall of risk-based testing
Is that an ingrown hair on your groin, a rash on your body, or a canker sore in your mouth? Actually, it might be syphilis.
After almost being eradicated 20 years ago, syphilis has not only made a comeback, but it has returned with a vengeance. The case count continues to rise despite a small decrease in 2020, presumably due to the COVID-19 pandemic.
Health care workers and funding were redirected to care for those affected by this devastating virus. Many sexually transmitted infection (STI) clinics across the country were forced to shut down while the public was urged to stay home except for medical emergencies. That year, congenital syphilis resurfaced in Humboldt County, after having vanished from Humboldt County for more than 10 years.
Congenital syphilis is a sentinel event, an avoidable event that leads to grievous harm or death. It is a warning that members of the community are slipping through the cracks. While newly pregnant individuals should seek prenatal care, they may not always recognize the need or significance of this visit. Further, poverty, poor health literacy, unstable housing, transportation, insurance status, substance use and language barriers are a few of the many barriers to prenatal care. California law requires health care providers to screen all pregnant people for syphilis during their first prenatal visit. Providers
should discuss and educate pregnant people about the importance of getting tested for syphilis and other STIs regardless of relationship status or risk factors. This is an example of one of many checks that can lead to the timely detection, treatment and prevention of congenital syphilis.
Local provisional data for 2021, show that there were 75 cases of syphilis, two of which were congenital cases, the highest number of cases Humboldt County has ever seen. This beat the previous highest record of 49 cases, which occurred in both 2018 and 2019. Public Health urges providers and the public to consider annual testing for all individuals who are sexually active regardless of risk factors, also known as routinebased testing.
Solution
Failure to detect and treat STIs in a timely manner increases the likelihood of an infected person giving the infection to more people. It also increases the likelihood of developing advanced stages of the disease. Traditionally, many health care guidelines suggest STI testing be “risk-based,” such as having multiple sex partners, a substance-use disorder, or being a man who has sex with other men. This creates a false idea that individuals without “risks” do not get STIs. In actuality, anyone can be affected by an STI.
These recommendations are also driven by data that is skewed towards urban communities, where most of the nation’s population resides. However, rural communities, such as Humboldt County, often have different demographics, practices and barriers compared to their urban counterparts. This means what works for the larger cities may not be what is best practice for smaller communities.
During medical visits, individuals may also choose to withhold information regarding sexual practices, substance use and number of partners, fearing stigma and chastisement. Annual routine-based STI testing would make it easier for someone who is uncomfortable with disclosing information to still be tested.
Closing thoughts
After the last two years of an ongoing pandemic, many individuals might feel medical and testing burnout. However, as life moves towards normalcy again, individuals should tend to any delayed health care needs. As we peek our heads from the thick of it, more than ever, it is crucial that we remember many illnesses such as syphilis never once stopped relenting. STIs do not discriminate based on risks. They only need to come into contact with you. Now is the time for all sexually active individuals to be tested for syphilis and other STIs, so call your health care provider to schedule an STI test today.