12 probable cases of syphilis reported in Santa Cruz County

SANTA CRUZ >> Public health authorities have reported a syphilis outbreak in Santa Cruz County after several cases were identified in the South County region.

As of Thursday, the county had 12 probable cases of syphilis, the vast majority of which were in South County and among individuals experiencing homelessness, according to county Deputy Health Officer Cal Gordon. The updated figures come days after a public health advisory addressed to the county's health care providers was uploaded to the county Health Services Agency's website March 14 explaining that several cases of syphilis were identified in Watsonville in late February.

Gordon said Thursday that he was not aware of any hospitalizations or deaths associated with the illness and that health officials were waiting on results from a number of other suspected cases.

“Syphilis is preventable,” Gordon said. “Right now the outbreak is in one population but it can certainly occur in other settings. So I think people need to practice safe sex: use condoms, get screened for (sexually transmitted diseases).”

Syphilis, according to the advisory, is a sexually transmitted infection caused by the bacterium Treponema pallidum and, if left untreated, it can spread to the brain and nervous system. An infection during pregnancy can carry significant adverse outcomes, including fetal death.

Within days of the outbreak, Gordon said the county, alongside the Homeless Persons Health Project and its mobile clinic, began intensive outreach, education, testing and treatment in coordination with the city of Watsonville and other partners.

But, county Health Officer Lisa Hernandez said in the advisory that the outbreak is also concerning, given that there is an ongoing national shortage of Bicillin L-A, a brand name for penicillin, the antibiotic used to treat syphilis. Gordon said the county is working with the California Department of Public Health to secure additional doses with the shortage forecast to continue through the summer, but “at this point we believe we have adequate amount of supply and access to additional supply should we need it.”

The advisory comes amid a separate bacterial outbreak that officials have been battling since January. As of Monday, 37 cases of shigellosis had been confirmed, primarily in the North County region, also among individuals experiencing homelessness.

Syphilis is often referred to as “the great pretender,” as symptoms often look similar to other diseases and can follow a progression of stages that can last weeks, months or even years. The first or “primary stage” of the illness may include a single or multiple sores, also known as a “chancre,” that are usually firm, round and painless and often appear in or around the genitals, rectum, anus, lips or mouth, according to the advisory. The sores last three to six weeks and heal regardless of whether a person receives treatment, but if no treatment is received, the infection will progress.

Subsequent stages include the continued spread of rashes or sores, a latent stage with no obvious indications or symptoms and a final “tertiary stage” that can impact the body's major organs such as the heart and brain.

A baby born to a person with syphilis, or congenital syphilis, also can have serious consequences such as a miscarriage, premature birth or stillborn birth.

According to the advisory, syphilis cases have been increasing in the county at a concerning rate in recent years. In 2022, 120 primary, secondary and early latent cases were reported to Santa Cruz County Public Health, which is more than double the 2020 total. Last year, 85 cases were reported, with 36%, or about 30, occurring among people experiencing homelessness. Women represented about 27 or 32% of cases in 2023.

No congenital syphilis cases have been reported since the three that were documented in 2022.

According to the advisory, individuals are at risk of contracting syphilis if they are sexually active and are at higher risk if they:

• Engage in high-risk sexual activity such as having sex without a condom, having multiple sexual partners, having anonymous sex, and/ or having sex while using drugs.

• Have HIV or other sexually transmitted infections.

• Are taking pre-exposure prophylaxis for HIV prevention.

• Have partner(s) who have tested positive for syphilis.

Those looking to get connected with care can call 831-454-4838. STD testing opportunities are at santacruzhealth.org/stdtesting.