Syphilis Cases Rising in Iowa

In the last two decades, cases of infectious syphilis in the U.S. have increased by 800%, from 2 to 18 cases per 100,000 people. In Iowa, rates have risen 268% in the last five years, including a 796% increase among females and a 333% rise in cases of congenital syphilis (when passed from mother to child). While most new cases are found in white males, syphilis affects people across all backgrounds and areas. Longstanding disparities remain for Black and Hispanic Iowans, and increasing cases are now being seen among American Indian and Alaska Native populations nationally and in Iowa.

To address this, all sexually active adults are encouraged to get screened. Partners of individuals diagnosed with primary, secondary, or early latent syphilis should also get tested and consider preventive treatment. The American College of Obstetrics and Gynecology advises that pregnant women should be screened three times: at their first prenatal visit, at the start of the third trimester, and at delivery. Women arriving late for prenatal care should be screened immediately. Babies should only be discharged if their mothers have been tested, and any baby born to a woman with syphilis should be checked for congenital syphilis.

Understanding and Identifying Syphilis Stages

• Primary Syphilis: Often shows as one painless sore, but can also appear with multiple or painful sores.
• Secondary Syphilis: May include a skin rash, mouth sores, and swollen lymph nodes.
• Tertiary Syphilis: Can affect the heart, bones, nerves, and cause severe health issues.

At any stage, the infection can spread to the nervous system (neurosyphilis), eyes (ocular syphilis), and ears (otosyphilis), causing symptoms like headaches, vision problems, and hearing loss. Health providers in Iowa are seeing syphilis cases with these symptoms.

Treatment Options and New Prevention Approaches

Syphilis is typically treated with an injection of benzathine penicillin G (Bicillin L-A), with doses adjusted by the infection stage. It’s important to start treatment promptly, even if the patient has a penicillin allergy—alternate treatments are available on the CDC’s website.

For some individuals, taking 200mg of doxycycline within 72 hours after unprotected sex can lower the risk of syphilis, gonorrhea, and chlamydia. This is known as DoxyPEP, and it can be taken regularly depending on a person’s activity level (not to exceed 200 mg per day).