El Paso Matters – Syphilis has increased dramatically in El Paso since 2020. What is being done about it?

Syphilis, long feared as “the great imitator,” has surged back into prominence in El Paso, where cases have risen at an alarming rate during the past five years.

The staggering 426% increase in syphilis cases since 2013 has become a pressing public health crisis for the city, which is grappling with the resurgence and consequences of a disease that is often undetected until it’s too late. Spiking after the pandemic, syphilis cases jumped from 297 cases in 2019 to 715 in 2023, according to data from the El Paso Department of Public Health.

The rise in cases in El Paso follows a national trend of increased syphilis cases in the U.S over the last eight years. In June 2023, the Centers for Disease and Control Prevention officials sent a letter to grantees explaining the loss of funding for sexual transmitted infections prevention programs.

With lack of funding, the CDC said it is unable to provide support for services as they once could, such as screening for STIs and medication used to treat them. This involves penicillin, an antibiotic that kills bacteria, including the bacteria that causes syphilis. 

El Paso’s intern health authority, Dr. Hector Ocaranza, said the state instructed counties to focus penicillin towards specific groups of people.

“There was a penicillin shortage, and the shortage is getting better, but we still got instructions from the state that we are still going to continue to prioritize the administration of penicillin to high-risk groups,” Ocaranza said. “Those high-risk groups are pregnant women, because they cannot receive any other medication, and those who are allergic to doxycycline or tetracycline.”

Because of its atypical symptoms, syphilis often goes undiagnosed. In early stages of syphilis, the CDC reports that chancres/sores and rashes appear. However, as the STI develops, it can cause paralysis, hearing loss, dementia and even death if left untreated. 

Furthermore, syphilis is often referred to as “the great imitator” by medical professionals because symptoms often mimic other diseases.

The public health department reported that 81.2 per 100,000 people tested positive for primary and secondary syphilis, congenital syphilis, and “late” syphilis in 2023. The sheer numbers are the highest the city has seen in the 2000s.

Once someone tests positive for syphilis in El Paso, Ocaranza said the city tracks their sexual partners to encourage them to get tested. To spread awareness, Ocaranza said the city recently began to do interventions about syphilis and other STIs. 

Besides syphilis, gonorrhea and chlamydia trachomatis infections have spiked within the last five years, according to health department data. 

Gonorrhea and chlamydia hit their peak in 2019 before dipping significantly in 2020: Gonorrhea had 1,898 cases, while chlamydia had 5,837 in 2019. Chlamydia cases have increased steadily since 2020 to more than 5,000 in 2023; while gonorrhea cases hit more than 1,200 that year.

Angie Márquez, clinic coordinator and marketer at Texas Specialty Clinic, takes a patient’s blood pressure. (Photo illustration by Corrie Boudreaux/El Paso Matters)

To help curb the positive cases throughout the city, sexually transmitted disease testing and treatment centers are available throughout the city. Among them is Project Vida, a nonprofit that provides different community services, including sexual health services. 

Jasmine Peralta, physician assistant for Project Vida, said most of the patients she sees are within the young adult (25) to older (40) age group.

Syphilis cases in El Paso babies, mothers

Referred to as congenital syphilis, pregnant women with the untreated STI can pass it on to their baby. CDC data shows that from 2018 to 2022, congenital syphilis in the U.S. has risen by 183.4%.

In Texas, the Department of State Health Services confirmed 922 women tested positive for congenital syphilis in 2022. That’s nearly a 1,116% increase over 2013, when Texas only reported 73 cases.

According to the DHS, El Paso County reported 16 positive cases of congenital syphilis in 2022.

Jessica Romero, physician assistant for Project Vida, said congenital syphilis cases in El Paso are at alarming levels. In 2022, 230 out of every 100,000 pregnancies resulted in a mother testing positive for congenital syphilis in Texas. 

“When (babies) are born with syphilis it can damage different parts of their body, like for example if you have that infection in the brain, that can affect vision, hearing, vision which is bad for a newborn baby,” Romero said.

The mortality rate of a baby with untreated syphilis is 40%.

“The babies do not have the normal natural defense systems to battle the bacteria syphilis, and having the congenital syphilis – four out of 10 babies pass away, sometimes before they are born,” Ocaranza said.

Nancy McGrail, director of Mother Baby and Nursery at University Medical Center of El Paso, said syphilis can be harder to identify in a woman than a man, posing a greater risk for women.

“In the early stages, usually the person will have a noticeable sore on their genitalia,” McGrail said. “But what’s different about women is that those regions are on the inside, and not easily detected.”

McGrail said despite the national penicillin shortage, UMC ensures every patient receives the antibiotic.

“Nobody goes without the penicillin that they need, if (a patient) needs penicillin, they will get it,” McGrail said. “Our pharmacy does surveillance on all medication shortages, and they are really good at finding resources throughout the country.”

Medical professionals encourage prenatal care to prevent the possibility of congenital syphilis. But, because of El Paso’s proximity to Mexico, McGrail said there are many women who often go without prenatal care.

“What’s unique about El Paso is that a lot of women don’t get prenatal care, they’re either coming from Mexico, or they don’t have a primary care provider, and so they come into the hospital not knowing they have syphilis,” McGrail said. “(However, UMC) offers prenatal classes, and any of the women who seek treatment with our OB-GYN providers (have) education is provided as well.”

Regardless of the negative stigma around STD testing, Peralta encourages El Pasoans to get tested frequently.

“There are way more STDs out there than people realize, and a lot of STDs don’t have symptomatic presentations a lot of the time,” Peralta said. “So, you can have an infection without realizing it at all and you can pass it on to people which will increase the problem.”

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