The number of people with sexually transmitted diseases is on the rise in the U.S. Alabama ranks sixth in the nation. The biggest increase is syphilis. That’s a disease the medical community thought was almost eliminated twenty years ago. New data from Alabama Public Health shows the syphilis rates have more than doubled across the state since 2020. Here’s more on the trend and what residents can do about it. And a note to our readers, this story contains content of an adult nature.
“Our syphilis numbers continue to increase. They have been increasing since the COVID pandemic of 2020.,” said Anthony Merriweather. He is the STD Director for the Alabama Department of Health.
“Our numbers started to go up in 2021 and have not slowed down,” he observed. “Our number of chlamydia and gonorrhea cases continue to increase over the same time period. We are having more infants being diagnosed with syphilis than we've ever had before.”
Merriweather says the cases are increasing for several reasons. One is COVID. County health departments ran limited operating hours during the pandemic. Private providers were also closed to patients needing testing.
“There were a lot of people during 2020 and first part of 2021 who didn't get tested or treated for their STIs because there was no place to get tested,” he said. “We're seeing the after-effect of the Covid pandemic and shuttering all of our public health and private health facilities.”
After the pandemic, clinics re-opened. But Meriweather says that doesn’t guarantee people know where to get tested.
“Particularly if they live in rural communities where they may be only one or a handful of providers,” he said. “The County Health Department may be open a few days during the week for STI and HIV screenings.”
But an easier testing solution also came from the pandemic. ADPH started what’s called the STD/HIV Home Specimen Collection Initiative in April 2021. The program provides tests for chlamydia, gonorrhea, syphilis, and HIV. The free kits can be ordered from the ADPH website. Merriweather says residents from every county in the state have asked for them.
“We ask patients why did you choose to test with this new initiative? A lot of them say they prefer the privacy of testing in their own home,” he recalled. “They don't feel comfortable talking to their provider about their sexual behavior. They don't know where to get tested. A large amount, particularly in rural Alabama, indicated they had no transportation to get to a provider for testing.”
A positive test is followed up with contact from a healthcare provider and a prescription for treatment. A penicillin injection cures the early stages of syphilis.
“If we don't feel comfortable talking to our healthcare provider, some people could go to the healthcare provider and still leave there without the testing that they needed,” said Tiffany Moseley, Director of Women’s and Children’s Services at Thomas Hospital in Fairhope. She spoke with APR at a coffee shop close to the hospital. She explains that stigma and lack of sex education are additional reasons for the spread of STDs in Alabama.
“They were too hesitant to say, I've been having oral sex, I've been having anal sex. A lot of people can't say those words,” Moseley said. “They are raised in houses and receive education that tells them that nobody should ever do those things. If you've been told that you should never do something, the last thing you want to admit is that you're having a problem after having done it.”
Data from Alabama Public Health showed an almost 300 percent increase in syphilis cases in women from the year 2020 to 2023. Moseley says the number of children born with syphilis passed on from the mother is also rising. But testing can catch syphilis early in pregnancy and treatment can protect the baby, preventing complications after birth.
“The problems are if a person doesn't have insurance, doesn't go in for prenatal care early, doesn't go in for all of their visits, has tested positive, or doesn't understand that they need to get fully treated,” said Moseley. “That's where we could end up with children who were born with congenital syphilis. The State of Alabama has had many more of those children in the last year for which we have data, than we did ten years ago.”
Moseley says Alabama must be doing something wrong because syphilis is a preventable and treatable infection.
“We've got to roll those wheels back and figure out where we capture people who are having this infection and not realizing it so that we can more quickly get them into treatment,” she said. “They can be cured and not have children who also were born with a disease that they may not be able to be treated for.”
“We had a young guy who came in from our school program. He tested positive for urine infection and wanted to come back,” said Deanna Montieth, Clinic Director at Women’s Resource Center. The clinic started offering tests for STI’s in 2019.
“We offered the blood testing. He had no idea he had syphilis,” she observed. “It can go undiagnosed if they're not being tested.
“STI funding? That is an interesting question,” said Anthony Merriweather. We met him at the beginning of our story. He says federal budget cuts made last year reduced the agency’s Disease Intervention Specialists. This is the frontline staff that investigates HIV and syphilis cases.
“That was cut across the board for all states,” Merriweather said. “In 2024, Alabama lost roughly $3 million in funding for the DIS workforce development and STI. We've been fortunate that we were able to increase our state general fund dollars to help offset that just a little bit.”
“The reality is everybody has sex,” said Landon Nichols. He’s the Executive director of the Southern Region of Five Horizons. The agency provides testing, prevention, and support services for those with STIs in central Alabama. He says a recent testing event in Sumter County, Alabama set off alarm bells. Fifty percent of the STI tests that day were positive.
“A 50% positivity rate is absolutely alarming. He said.
Nichols says younger generations are a little more open to talking about sexual health, but it is still a tough nut to crack.
“You can't address an issue until you bring it out into the light,” said Nichols.
This story was made possible through a grant from the Caring Foundation.
