September 21, 2023 – It was just a routine check-up – or so she thought. But this time, Marnina Miller’s love interest came along. The pair went to an STD clinic in Houston, where Miller worked, to get tested syphilis and HIV.
With an already compromised immune system due to an HIV diagnosis nine years ago, it is crucial for Miller to ensure she is free of other diseases. She tested negative for syphilis. Her partner, on the other hand, tested positive for latent (or stage 3) syphilis.
Syphilis has been on the rise in the US for more than twenty years. According to the CDC, cases increased 75% (to 176,713) between 2017 and 2021. Houston – the fourth largest city in the US – appears to be the epicenter. Between 2019 and 2022, there was a 128% increase in syphilis cases, especially among women and people of color. according to to the Houston Health Department. This summer, drugmaker Pfizer reported widespread shortages of the antibiotic penicillin, which is used to cure early-stage syphilis and treat latent syphilis.
“I was immediately scared,” Miller said. “I was nervous about what that meant for me because we had kissed before. And although I live openly with HIV, there is little education about syphilis and how it is contracted.”
The Houston Health Department has warned Houstonians to take this public health crisis seriously by practicing safe sex and getting tested to see if they are sexually active. There has also been a ninefold increase in congenital syphilis – that is, when a pregnant mother passes the disease to her baby – in Houston and Harris County, Texas. To help prevent the spread, residents can now go free testing for sexually transmitted infections (STDs) at Houston health clinics.
“It is critical for pregnant women to seek prenatal care and syphilis testing to protect themselves from an infection that could lead to the death of their babies,” said Marlene McNeese Ward, deputy assistant director of the Houston Health Department’s Bureau of HIV/STI and Viral Hepatitis Prevention. She said a pregnant woman should be tested for syphilis three times during her pregnancy.
There are four stages of syphilis: primary, secondary, latent and tertiary. (See the symptoms of each stage here.) Oral, anal, and vaginal sex are some of the ways the disease can spread. Some people who contract syphilis never have symptoms and may have the disease for years without knowing it.
Penicillin can cure both syphilis and congenital syphilis. The antibiotic cannot reverse the damage to your organs caused by an infection, especially if the disease has progressed significantly before treatment.
Teriya Richmond, MD, explained what an average testing day looks like. Upon arrival at the testing location, you will be checked in and learn what types of STDs you can be tested for. The CDC recommends that you get tested for HIV, syphilis, hepatitis C, gonorrhea, and chlamydia. Syphilis testing is done through blood samples. Testing for other diseases includes oral or anal swabs and urine samples, says Richmond, a board-certified family medicine doctor who specializes in women’s health.
Sergino Nicolas, MD, is creating TikTok videos and Instagram videos to raise awareness about the outbreak. The Pittsburgh-based emergency physician said some people in their 20s and 30s often have a “casual” attitude toward STDs. Not being aware of the consequences of syphilis could lead to this attitude. “With thoughts like, ‘I can just get treated,’ I think there’s a danger in that, because if you have these infections, [irreversible] Complications can arise,” he said.
Prejudices among this age group that oral sex is a safer alternative to vaginal or anal sex are also common, Nicolas said. “Any time you have infected secretions or are exposed to mucous membranes, including the vaginal mucosa, it can result in the spread of the infection.”
Women of color have been particularly affected by the outbreak. Syphilis has a wide range of signs and symptoms, and that could play an important role, Nicolas said. Lack of education about the dangers of unprotected sex, especially if you have multiple sexual partners, could be another reason, as it increases the rate of yeast infections and STDs, he said.
Another potential factor: Sexually explicit music and entertainment can also cloud judgment about whether to engage in sexual activity, Nicolas said. Younger generations in particular can fall prey to this. “There have been new artists in recent months who have really pushed for ‘female empowerment’ in a sense,” he said. “At the same time, they may also advance a narrative that is more concerned with promiscuity, which could result in certain psychological effects” that could lead to unsafe sex practices.
Public health activists in Houston are spreading the word about the importance of testing for STDs. Kevin Anderson is the founder of the TRUTH Project, a Houston-based nonprofit organization that educates and mobilizes LGBTQ communities of color through social arts that promote sexual, mental and physical health.
As the TRUTH Project celebrates its 10th anniversary, it is creatively promoting education and awareness about syphilis. The organization’s recent events have included an open-mic night called “Heart and Soul,” with free on-site STD testing for attendees. It also hosted a sex-positive evening with the aim of educating visitors about STDs and safe sex practices. Self-love, self-care and self-awareness of your body are among the group’s most prominent messages. “If something feels or looks different, love yourself enough to be proactive and find out what’s going on — because avoidance leads to outbreaks,” Anderson said.
Maybe you are afraid that you are STD positive. Or maybe you are getting tested for the first time. Remember, you monitor your sexual health and are in control of your body, Miller said. “Don’t be afraid. Take care of you.”