Sharp rise in syphilis cases draws concern
Health officials say STD testing, prompt treatment can prevent spread
June 30, 2022
Syphilis cases rose sharply in Minnesota in 2021, bringing them to concerning levels, according to an annual report of sexually transmitted diseases and HIV data from the Minnesota Department of Health.
The increase in syphilis cases in the state mirrors a disturbing national trend of starkly rising syphilis cases, affecting all communities, health officials said. They renewed their call for regular testing and prompt treatment to help stem the tide. The annual report also notes special concern related to the syphilis outbreak in the Duluth area and a sustained increase in Cass and Beltrami counties.
While the syphilis increase was clear, comparing STD rates generally from one year to the next may be difficult, health officials cautioned, because it’s not yet clear what impact the pandemic has had on behaviors. Although statewide 2020 data showed a decline in some STD rates, epidemiologists believe there may be more nuance behind the 2021 annual report data. “It may take time to assess and understand how COVID-19-related disruptions to health care access or health care seeking behaviors may have impacted and changed the screening rates of STDs and HIV, compared to the pre-COVID-19 era,” explained Christine Jones, STD, HIV and TB section manager.
“What we do know is that the rates of syphilis are troubling, especially the rise in congenital syphilis (CS), or when a pregnant person passes syphilis to an infant,” Jones said. In 2021, cases of CS in Minnesota increased by 115%, up to 15 cases. “CS can cause low birth weight, harm, or death to an infant if not treated. It is preventable when it’s caught early,” Jones said. “We are encouraging people to get tested regularly for STDs, especially if they are pregnant.”
Despite the COVID-19 pandemic, STDs remained at near historic high levels, with 33,706 STD cases reported in 2021 compared to 33,245 cases in 2020 – a 1% increase.
• Syphilis cases reflected the greatest increase from 2020, with a 33% increase, to 1,457 cases reported in 2021. Fifteen cases of congenital syphilis in infants were reported in 2021. This is a 115% increase from 2020 when seven congenital syphilis cases were reported.
• Chlamydia remained the number one reported STD in the state, with 22,578 cases reported, a 3% increase compared to 2020. Most of the cases (59%) occurred in teens and young adults ages 15 to 24. One in three cases occurred in Greater Minnesota, with at least two cases reported in every county in Minnesota.
• Gonorrhea remained the second most reported STD in Minnesota, with 9,671 cases reported in 2021, a 5% decrease. This follows a substantial increase in 2020.
Overall, the number of newly diagnosed HIV infections reported to MDH increased 8%, with 298 cases reported in 2021 compared to 275 in 2019 (2019 data are used more reliably here due to COVID-19 disruptions in HIV testing services and access to clinical care impacting HIV diagnoses in 2020).
• Almost two-thirds (65%) of new HIV cases affect communities of color.
• The number of reported people living with HIV/AIDS in Minnesota is 9,697.
Two ongoing outbreaks of HIV have influenced the number of newly diagnosed cases in 2021: the Hennepin and Ramsey County outbreak declared in February 2020 and the Duluth area outbreak declared in March 2021. Minnesota's outbreak-associated cases have risk factors consistent with the national outbreaks. Those include:
• People who use injection drugs or share needles and works.
• People experiencing homelessness or unstable housing.
• People who exchange sex for income and other needed items.
• Men who have sex with men (MSM).
Syphilis increases highlight need for testing, prevention
In 2021, the “sustained increase” of syphilis, now known as a consistent area of concern, continued in Cass and Beltrami counties, and a syphilis outbreak was declared in the Duluth area, which includes the 30-mile radius around the city. However, syphilis everywhere remains a critical concern. Untreated syphilis can cause blindness, dementia, or even death. New infections continued to be centered within the Twin Cities metropolitan area and among males, particularly among men who have sex with men (MSM). However, the increasing presence of syphilis among females was alarming, especially because of the risk of congenital syphilis in those who are pregnant or of child-bearing age.
Preventing syphilis and congenital syphilis is possible with antibiotic treatment, testing, and education, health officials said. “We know how to prevent STDs and HIV and we know how to prevent congenital syphilis,” said Dr. Ruth Lynfield, medical director at MDH. “People need to know they can protect themselves and their infants by consistently using condoms and by getting tested for syphilis and other STDs, and if positive, by getting treatment and informing their sexual partners.”
Pregnant women should be tested for syphilis at the first prenatal visit, early in the third trimester, and testing may also be considered at delivery, Lynfield said. “For those at risk, it is helpful for HIV prevention to take the daily pill to prevent HIV (PrEP), and if you are diagnosed with HIV, it is important to get on and stay on treatment to lower your viral load, since undetectable equals untransmittable,” she noted. “Also, it’s important to remember that many STDs, including syphilis, may not have symptoms or may have symptoms that you miss because they mimic other illnesses. If you’re sexually active, especially with multiple partners, consider including testing for STDs and HIV into your regular health routine.”
More information, as well as the complete Minnesota 2021 Surveillance Reports for STDs and HIV, can be found on the STD Statistics page on the MDH website.