Syphilis in MS is on the rise. What counties have the highest rates?

Former State Health Officer Dr. Thomas Dobbs recently sent out a tweet saying Forrest County's rate of syphilis cases is three times higher than Hinds County.

Dobbs, who resigned from his position in July 2022 as the coronavirus pandemic appeared to be on a decline, said Forrest County — and the Pine Belt region — is a "hotbed of syphilis in Mississippi."

"Docs and providers — think about syphilis in your patients," he wrote.

From the data Dobbs shared on Twitter, Forrest County has the second-highest rate in Mississippi for number of cases of primary and secondary syphilis per 100,000 people in 2021, the most recent figures available. Only nearby Covington County's rate was higher. In 2020, Forrest County again had the highest rate, second to Coahoma County in the Delta.

But what does that mean? The Mississippi State Department of Health helps explain what syphilis really looks like across Mississippi.

The most recent report provided by the Centers for Disease Control and Prevention that was available to review was from 2021. The figures for that year and 2020 come with a warning that the data may not paint an accurate picture.

One reason given by the CDC was the disruption of STI-related prevention and care services that started in 2020 with the surge of COVID-19 cases. The lack of available services likely continued into 2021, the CDC reported.

The 2021 rate for Forrest County was 109.1 cases per 100,000 people, just under Covington County's 109.4. Hinds County's rate in comparison was 36.4 — like Dobbs said, about a third of Forrest County's case rate.

Forrest County's 2020 syphilis rate per 100,000 people is 94.8. Coahoma County, in the Delta, is 94.9. In contrast, Hinds County's rate is 34.5 cases per 100,000 for the year 2020.

Looking at actual numbers of cases reported, Hinds County had a total of 80 cases reported in 2020, compared to Forrest County's 71. Coahoma County reported 21 cases in the same year.

Forrest County cases took a leap in 2021, reporting 85 cases to Hinds County's 81 — the first and second-highest number of cases that year. Covington County reported 20 cases in 2021.

What makes the difference in the rate vs. number of cases is the population of each county. Hinds County had around 230,000 residents in 2020 and 2021, while Forrest County reported approximately 75,000 residents during the same period. Coahoma County recorded just over 22,000 residents in 2020. Covington County's population in 2021 was about 18,300.

2019: Mississippi has the highest rate of this STD, ranks 3rd for two others

Despite possible anomalies in the reporting of syphilis cases during the pandemic, it is likely the upward trend will continue, State Epidemiologist Dr. Paul Byers said in an email, but that trend is not just limited to Mississippi. That trend is expected to continue, he said.

In fact, the increase in syphilis cases in Mississippi began before the pandemic, leading the nation.

"The increases in syphilis are being seen across Mississippi and are really seen nationally as well," he said. "The increases are likely multifactorial, and include better identification and reporting of cases."

In addition to better documentation of syphilis cases, social factors could be the cause of the rise in not only syphilis, but other sexually transmitted infections — like gonorrhea and chlamydia — as well.

"It is important to consider the impact of the growth of illicit drugs as well as increased use of anonymous online dating services which can lead to difficulties identifying contacts to test/treat," Byers said.

Byers, who announced he will retire at the end of June, did not specifically address why cases were going up in Forrest County or why cases in Hinds County are decreasing.

Attempts to reach other medical professionals for comment were unsuccessful.

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So what is being done to fight the continued rise of STI cases in Mississippi?

Byers said much is being done at the state level.

"Maintaining public health infrastructure is important, and MSDH continues to prioritize increased staffing, increasing provider communication and support, and modifying testing requirements to limit the impact," he said.

One of the new requirements is the addition of syphilis testing during pregnancy. Pregnant women should be tested for syphilis in the first and third trimesters and again at delivery, Byers said.

"Congenital syphilis can be prevented with appropriate testing and treatment," he said. "If you are pregnant, make sure you are tested. If you test positive while pregnant, make sure you are treated appropriately with penicillin."

If left untreated, congenital syphilis can lead to long-term health problems in the child or may cause preterm birth or miscarriage.

"We are doubling down on our efforts to ensure that positive pregnant women are identified, reported to MSDH and treated," Byers said. "We are working with our partners to ensure providers are aware and understand the new testing and reporting requirements. Testing and reporting by providers is key."

Sexually active people also can do their part to prevent the spread of syphilis, Byers said. Learn about the disease and its symptoms. If you suspect you may have an STI, get tested.

"Syphilis can be treated very effectively and is easy to prevent when partners are treated," Byers said.

Symptoms of early syphilis can be a genital ulcer or a rash, which also sometimes appears on the palms or soles of feet. The rash or ulcer will go away, even if left untreated. The other symptoms will disappear over time. But that does not mean the disease itself is gone. Asymptomatic infected people can still infect others, sometimes for years after initial contact.

Nationwide, syphilis cases increased by about 30% in 2020 and 2021. Nearly half the cases reported are in men who have male sexual partners, the CDC reported. But the number of female cases is rising sharply, having increased 55.3% in 2020-21 — 217.4% from 2017 to 2021.

It is important to note that these disparities are unlikely explained by differences in sexual behavior and rather reflect differential access to quality sexual health care, as well as differences in sexual network characteristics. For example, in communities with higher prevalence of STDs, with each sexual encounter, people face a greater chance of encountering an infected partner than those in lower prevalence settings do, regardless of similar sexual behavior patterns. Acknowledging inequities in STD rates is a critical first step toward empowering affected groups and the public health community, to collaborate in addressing systemic inequities in the burden of disease — with the ultimate goal of minimizing the health impacts of STDs on individuals and populations.

More than half the cases reported in 2021 were in teens and young adults, 15 to 24.

Do you have a story to share? Contact Lici Beveridge at lbeveridge@gannett.com. Follow her on Twitter @licibev or Facebook at facebook.com/licibeveridge.

This article originally appeared on Hattiesburg American: Forrest County leads Mississippi in rate of syphilis cases