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South Dakota syphilis outbreak continues despite testing and awareness

Syphilis Chart
SDPB graphic by Andrew Kronaizl
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Data source: SD Department of Health
The number of syphilis cases reported by the South Dakota Department of Health from 2016 to 2021.

South Dakota has experienced a spike in syphilis cases over the past couple of years, with the state trying to test and treat more individuals, including those with high risk factors.

According to the South Dakota Department of Health’s infectious disease dashboard, the state reported 785 adult cases of syphilis in 2021. That's an increase of more than 1800% from 41 cases in 2016. The state has recorded 662 cases so far in 2022.

Angela Cascio, the Department of Health’s infectious disease director, said case detections will likely continue to rise, partly due to a push for more testing.

“And I think it'll take some time for those interventions to take place and for us to see a decrease,” Cascio said.

According to Cascio, one potential cause for the current outbreak is the impact of the COVID-19 pandemic on preventative health care.

“There were likely individuals that may or may not have been symptomatic that were not seeking preventative care or maybe even going in for care if it wasn't something that they felt was very serious,” Cascio said.

One of the Department of Health’s main goals is educating people about the current rate of syphilis, how it’s contracted, what symptoms look like, and what treatment is available.

Syphilis is a bacterial infection that is spread through direct contact with syphilitic sores. Infections often occur during sex.

According to the federal Centers for Disease Control, symptoms can occur between one to 90 days after infection, with the first symptom being the appearance of sores. The sores go away after three to six weeks, but the infection will continue unless treated. If untreated, syphilis will later cause rashes, and 10 to 30 years after infection, it can become fatal.

For most cases, treatment is a single shot of penicillin, though it can increase to three shots for longer-term cases.

Native Americans disproportionately affected

The Great Plains Tribal Leaders’ Health Board, an organization that provides health services for tribal communities in South Dakota, North Dakota, Iowa and Nebraska, has been working to promote syphilis awareness in the tribes it serves.

In South Dakota, the current syphilis outbreak has been disproportionately affecting Native American communities.

So far in 2022, about 75% of South Dakota's cases are attributed to Native Americans. Besides Minnehaha and Pennington, the counties with the highest number of cases are Todd and Oglala Lakota, which are located within the Rosebud and Pine Ridge reservations, respectively.

According to Meghan O’Connell, an epidemiologist with the Health Board and a member of the Cherokee Nation, the organization is trying to reduce the stigma of syphilis.

“There's no shame in having an STD,” O’Connell said. “It should not be considered something to be embarrassed about, and certainly no one should ever feel embarrassed by asking to be tested or talking to your health care provider about it.”

Testing offered

While awareness has been a major goal during the outbreak, the Department of Health and other organizations are also increasing opportunities for syphilis testing and treatment.

The Union Gospel Mission in Sioux Falls started working with the Department of Health earlier in the year to provide testing to homeless and low-income individuals. According to the Department of Health, people with unstable housing are at a higher risk for syphilis.

Eric Weber, the CEO of the Union Gospel Mission, said the organization wants to look out for the health of the people it serves.

“We want to make sure our community is impacted in a real way,” Weber said. “A lot of people or different organizations talk about reaching lower income individuals and the homeless community, but very little action is taken to offer these services and resources to those in need."

In addition to syphilis in adults, South Dakota is also experiencing a rise in congenital syphilis, which is when pregnant mothers with syphilis infect their children at birth.

According to information from the Department of Health, the number of congenital syphilis cases reported was 16 in 2021, a 700% increase from the two cases reported in 2016.

Both the CDC and South Dakota's Department of Health recommend pregnant women get tested three times during their pregnancy: at their first prenatal visit, at the start of the third trimester, and when coming in for delivery.

Andrew Kronaizl is a senior at Augustana University. He is from Vermillion, SD, and is based out of SDPB's Sioux Falls studio.