South Dakota has a syphilis problem

Tyler Broghammer leaves his office almost every day armed with a small blue cooler.

Inside is a weapon against the syphilis epidemic in South Dakota: penicillin syringes. The sexually transmitted infection case manager at Oyate Health Center in Rapid City also carries rapid STI tests and condoms on his almost daily trips around town, meeting people he has learned might be affected by the disease.

Broghammer is one of two STI case managers at Oyate Health who find and treat people with syphilis. The organization is one of several working to combat the outbreak in South Dakota through collaborative partnerships.

COVID-19 testing is “completely outdated”

Syphilis is a bacterial infection that is most commonly spread through sex and can be cured, but can cause serious health problems without treatment and can be passed from mother to unborn baby.

South Dakota saw a 2,493% increase in adult syphilis cases compared to the five-year median in 2022, according to the state Department of Health, with 1,504 cases reported – the rate of highest cases of syphilis in the country at the time. This represents an increase of 90% compared to 2021.

The number of syphilis cases in the state dropped in 2023 to 1,374 cases, according to the state’s infectious disease dashboard.

Syphilis cases decreased by 335 cases in the first quarter of this year compared to 2023, according to a spokesperson for the state Department of Health.

The state had the second-highest rate of congenital syphilis in the country in 2022 with 40 cases, or 351.8 cases per 100,000 births, a 150% year-over-year increase. The state saw a 1,233% increase in congenital syphilis among infants compared to the five-year median in 2022.

The state reported 54 cases of congenital syphilis in 2023 and 18 through April of the same year. So far this year, nine cases have been reported.

A cooler is filled with doses of penicillin April 24, 2024 at Oyate Health Center in Rapid City. (Seth Tupper/South Dakota Spotlight)

Syphilis was on the verge of being eradicated in the United States in the 1990s, but cases in South Dakota were increasing in the years before the COVID-19 pandemic. Syphilis infections nationwide have increased rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. The increase comes amid a shortage of penicillin, the most effective treatment, due to increasing cases of syphilis nationwide. The shortage is expected to last until the end of this year.

Hospitals were overwhelmed with coronavirus treatment in 2020 and 2021 and patients were hesitant to get tested or treated for STIs, said Meghan Curry O’Connell, a member of the Cherokee Nation and director of public health at the Council of health of Great Plains tribal leaders. in Rapid City.

“The whole system we have to make sure people are screened and treated for STIs has been completely overwhelmed by COVID, like everything else,” said Curry O’Connell, a family physician by training. “Particularly in South Dakota, additional challenges included difficulty accessing care in very rural areas, which compounded the impacts of the pandemic. »

Native American communities hardest hit

Native American communities have been hit hardest by the outbreak in South Dakota and nationally. About 90% of congenital syphilis cases in South Dakota involve Native babies, according to the state Department of Health.

Syphilis causes a range of symptoms, including rashes, sores and hair loss. But if the disease is left untreated, symptoms can disappear even if the infection persists, making it a prolific vector for spread unless sexually active people are informed about the disease, engage in sexual practices protected and are not regularly tested, Curry O’Connell said.

The disease can potentially persist for decades if left untreated, which can lead to death. If pregnant women become infected, it poses a dangerous risk to their babies; Congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis and even death. In 2022, the CDC recorded 231 stillbirths and 51 infant deaths caused by syphilis nationally, out of 3,761 cases of congenital syphilis reported that year.

The Great Plains Tribal Leaders’ Health Council and tribal leaders in North Dakota, South Dakota, Nebraska and Iowa have asked the federal Department of Health and Human Services to declare a public health emergency in their states. A declaration would increase staffing, funding and access to contact tracing data in their region.

“It’s important to get treatment because we want to avoid these consequences, and it’s so easy for people to do,” Curry O’Connell said. “Most people only need one injection of penicillin if they are newly infected.”

The rate of congenital syphilis infections among Native Americans (644.7 cases per 100,000 people in 2022) is comparable to that of the entire U.S. population in 1941 (651.1) before doctors began to use penicillin to cure syphilis, according to KFF Health News.

The risk is particularly high for people with limited access to health care.

“If you delay care or don’t have a regular relationship with a doctor, these people are more likely to go untreated,” Curry O’Connell said. “Whatever the reason or obstacle – if a person can’t take time off from work, if they have a distance to travel, if they don’t have immediate transportation or whatever – it The symptom may disappear.”

How SD entities are coping with the epidemic

Broghammer’s position is funded by a grant from the Indian Health Service. His “hands-on” method is the most effective way to treat patients, although it’s also a “chore,” Broghammer said.

Whether due to homelessness, financial or privacy concerns, many patients have difficulty finding their way to Oyate Health on Rapid City’s west side, Broghammer said. He will meet patients anywhere: at their home, at the hotel or even in parking lots.

“Some days I get five to six phone calls, which is great. Other days we pick up the phone and try to locate people, but we may not find anyone,” Broghammer said. “It’s not as simple as a phone call and a meeting with them. We have a decent sized population of homeless parents where they are hard to find – without a phone or address. Sometimes we literally have no reason to leave.

Some other health systems will test for syphilis but not visit the patient.

“Underlying all of this is high resource consumption, particularly in rural areas,” Curry O’Connell said. “However, we do not yet know of anything that can replace it. Being on the ground, going out and talking to people, testing and doing what needs to be done is just basic public health work, and there’s nothing else that really works better.

Some tribes and Indian Health Service sites also send nurses to reservations in South Dakota to find and treat people. The state Department of Health plans to launch its Wellness on Wheels program in May, with five vans crisscrossing the state to provide basic health care to rural communities, including STI testing, treatment, education, counseling and referral to community resources.

The vans will also provide pregnancy care services, safe sleep counseling and child development screening, WIC services, maternal depression screening, immunizations and oral health care.

“We hope to use these vans several times per week to reach customers who may not have access to one of our physical locations,” Tia Kafke, the department’s media spokesperson, said in a statement. sent by email. “The vans will operate in winter as much as possible, weather permitting. »

The state, tribes and tribal health board hold monthly meetings on syphilis, Curry O’Connell said. IHS recommends that every patient age 16 and older be screened for syphilis at least once a year. Pregnant patients should be screened three times during their pregnancy.

Broghammer often receives calls from the state Department of Health with leads about people testing positive for syphilis.

“They save me time and energy, so I know they’re working hard,” Broghammer said.

The State Department began piloting a rapid testing partnership with a health care provider in Mission, on the Rosebud Reservation, in December. Fifty patients were tested in the first three months, with eight positive and treated for the disease.

The move to rapid testing is an important development, professionals agree, because patients can be treated immediately rather than days or weeks later when results arrive from labs. The department has seven normal testing centers across the state.

The number of syphilis cases in South Dakota has declined since its peak in 2022, although it remains at epidemic levels. Congenital syphilis is only prevented by treating pregnant women. The number of congenital syphilis cases in South Dakota increased from 2022 to 2023.

Prenatal care, a key intervention to combat congenital syphilis

While Broghammer sees the effect of these collaborations, he said there could be more entities working together in the state to put more troops on the ground.

Curry O’Connell said more effort is needed to test pregnant patients who are not receiving prenatal care. Nearly a third of congenital syphilis cases in the first half of 2023 did not receive prenatal care, according to the state.

Most women will continue to interact with the health care system at some point during their pregnancy, even if they do not receive prenatal care. They should then be screened with a rapid test, Curry O’Connell said.

“If someone is receiving emergency care or going in for something that’s not even pregnancy-related, that would be a good place to start, because a lot of women will receive some sort of care during pregnancy,” Curry said…

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