Syphilis Problem Not Showing Signs of Stopping in Travis Co.

Syphilis bacteria in a human skin lesion under microscope (not a cheesy casserole) (image via Getty Images)

Last week, the Travis County Com­mis­sion­ers Court received an update from Austin Public Health on sexual health issues and the interlocal response of APH and the county's RBJ Health Center – with concerning results. Most concerning is syphilis. Amid a nationwide increase in cases, Travis County's rate is higher than Dallas, Harris, Tarrant, and Bexar counties. And it's disproportionately affecting underserved populations in the county – the incidence rate for Black people in 2020 was three times higher than white people, and cases in the Latino community have increased fourfold from 2010 to 2020. What's worse, due to increased demand, there's a nationwide shortage of Bicillin, the Pfizer-produced medication used to treat syphilis.

Generally, STI rates are climbing in the county. Earlier this year, APH reported a 38% increase in clinic patients from 2021-22, and another 18% increase in the last year, reflecting an increasing need for STI services. (Patient numbers from 2019, however, were still higher.) The RBJ Health Center's protocol for stopping the spread of STIs has five staff nurses handling screening, treatment, and testing. Seven staff social workers then set up follow-ups tracking all HIV and syphilis cases – they interview partners, conduct further testing, and set people up with treatment.

"This seems like it has the potential to get much more serious over time," noted Com­mis­sioner Brigid Shea in reaction to these updates. "Are we really scratching the surface on this, or is this just a really bad losing game of catch-up?" Shea asked. APH responded that it's "a little bit of both," and that they are actively looking for ways to solicit grant funding and increase billing where it will impact people the least. They'd ideally like to open a new clinic farther north, but funding is an increasingly dire problem.

In September, the U.S. Senate passed the bipartisan Primary Care and Health Work­force Act out of committee, which is intended to boost funding for health care. The problem is it would shift some of that money – $980 million – out of the federal fund for prevention initiatives. Cassandra DeLeon, assistant director for APH's Disease Preven­tion Health Promotion Division, explained that APH will continue their public information campaign encouraging high-risk people to test, but offered a bleak outlook on expanding services to meet the increased need.

"We know with this rollback of funding potentially, that those who are underserved and underinsured, who are disproportionately affected already by these diseases," will be impacted even more, she said. "And public health resources will be more and more restricted to provide [them] support."