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Alaska’s syphilis cases more than doubled in a year, and COVID-19 has complicated outbreak response

The novel coronavirus isn’t the only dangerous infection currently making its way through Alaska: Cases of syphilis more than doubled between 2018 and 2019 and are on track to reach similar highs in 2020, according to a new report released by the state Thursday.

Syphilis, a sexually transmitted bacterial infection, begins as a painless sore on the genitals or mouth. Other early symptoms can include a rash on the palms or feet, and trouble with vision or hearing. When left untreated, syphilis can attack multiple organs, including the heart and brain, and even cause death. It can also be passed from mothers to unborn children.

The state’s syphilis outbreak was first declared in 2018, when 114 cases were reported to the state. In 2019, there was a record high of 242 new cases of the infection — a 112% increase from the year before. Largely driving the surge were new cases in heterosexual men and women. This was a change from the year before, when most cases involved men who had sex with men, said Susan Jones, an HIV/STD program manager with the state.

Outreach efforts including targeted messaging, contact tracing, education and treatment were initially effective in slowing the spread of the infection, Jones said in an interview Thursday. But now the epidemiology of the outbreak has shifted, at a time when public health resources are strained.

Many of the new cases were identified in people experiencing homelessness, Jones said — a group that has proven particularly difficult to reach for the necessary testing, treatment and contact tracing.

“If you don’t have a phone and we can’t locate you or find your partners, it makes it much more difficult,” she said, noting that the field work that was effective pre-pandemic — which included physical outreach in encampments — is no longer possible in the era of COVID-19.

People are also often reluctant to speak about their sexual history to strangers over the phone, she explained. This is a problem because the best and only way to stop any disease from spreading is to find and treat everyone who has been infected.

The rise in cases involving heterosexual couples and women also raises the risk that a mother could pass the infection on to her baby during pregnancy.

“Historical data show that up to 40% of pregnancies with untreated syphilis will result in miscarriage, stillbirth, or early infant death,” the report said.

The main way to reduce this risk is for pregnant people to get tested for syphilis during their first prenatal exam, Jones said.

“But you have to go in for prenatal care and some of these folks aren’t getting prenatal care,” she said.

Rising cases of syphilis are part of a larger sexual health problem in Alaska, which has had record highs in rates of other sexually transmitted diseases like chlamydia for years, Jones said. Partly this is because Alaska’s population skews younger compared to other states, which means higher rates of sexual activity.

Alaska is also not alone: Nationally, syphilis rates are on the rise, and have increased almost every year since 2001, according to the federal Centers for Disease Control and Prevention.

Meanwhile, a public health crisis rages on.

“This is a reminder that as we battle the COVID-19 pandemic, there are other outbreaks that need our attention,” Dr. Joe McLaughlin, state epidemiologist, said in a statement.

“We should probably be giving a mask and condoms to everybody right now,” Jones said Thursday.

The most important thing Alaskans can do to keep from contracting and spreading the infection is to use condoms, get tested regularly, seek prompt treatment and make sure all sexual partners regularly get tested and treated, Jones said. Planned Parenthood, local public health departments and some local clinics can provide free or sliding scale testing and treatment, she said.

Testing locations can be found at gettested.cdc.gov.

Jones expressed worry that some patients may be less likely to seek medical care during the pandemic out of fear of contracting the coronavirus. At a legislative hearing earlier this week, Jared Kosin, the president and CEO of the Alaska State Hospital and Nursing Home Association, emphasized how important it was for no one to avoid seeking necessary medical care — even at a time when health care capacity is being threatened by a surge in coronavirus cases.

“We get asked, ‘Should we cease medical visits and surgeries to clear the way for the impending wave?’ ” he said. “Let me be clear: The answer is absolutely not. Delaying medical care creates a whole set of other issues and problems.”

The good news is that unlike the coronavirus, syphilis has a cure. If detected early, it is easily treated with medication.

“With COVID, the only thing you can do is isolate people,” Jones said. “But with syphilis, you won’t acquire the infection if you get the treatment soon enough.”

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