Syphilis cases spike in Florida, especially in Orange County

Syphilis, a sexually transmitted disease nearly eradicated 20 years ago, is back on the rise in Florida, particularly in Orange County.

The infection increased by nearly 80% in the five years before 2022, the latest year of data available, according to the Centers for Disease Control and Prevention. Florida data shows the number of cases nearly doubled during that time, with 18,838 Florida residents living with syphilis in 2022.

Orange County saw 1,830 cases in 2022. It had the sixth-highest syphilis rate of any Florida county that year, according to state health department data.

Experts aren't positive why this increase has occurred—theories include reduced government investment in sexual health programs, decreased condom use, increased drug use and the rise of dating apps—but they're concerned. Serious health effects can occur if the infection is left untreated. To tackle this crisis, efforts must be made to reduce stigma and improve access to testing and treatment, experts say.

"In the early 2000s, we were talking about even, possibly, eradicating [syphilis]. And then it came roaring back," said Jill Roberts, associate professor for the USF College of Public Health. "We have similar data for chlamydia and gonorrhea, but syphilis is the one that really scares me."

During the pandemic, even more resources were diverted away from sexual health clinics to support the U.S. COVID-19 response, corresponding with a sharp uptick in diagnoses, Roberts said.

"What really happened around COVID is we had this large collapse of the health care system and public health," she said. "And so what we're seeing now is … we're lacking testing and treatment and education."

What is syphilis?

Syphilis is a curable disease caused by bacteria. It is spread through direct contact with sores and rashes through vaginal, anal, or oral sex, making condoms crucial to its prevention, though they are not 100% effective. It can also spread from moms to their unborn babies. It's thought to be transmissible only in the first two years of infection, according to the World Health Organization.

While it's historically impacted men who have sex with men, heterosexual people are increasingly contracting it, and many don't realize they have it.

Symptoms are easy to miss until it's too late. It starts with a small, often painless sore at the site of infection, which pops up anywhere from 10 to 90 days after someone contracts it. Then comes a rash that doesn't usually itch and may be faint.

These symptoms will go away without treatment but the disease can then lie dormant for years until horrific health effects, like organ damage, emerge.

Syphilis is easily treatable with antibiotics like penicillin. The antibiotics will cure the infection but won't undo any damage.

Why Orange County?

It's not known for sure why Orange County, in particular, is such a major contributor to syphilis diagnoses in the state, but there may be several factors.

For one, Orange has a large population of immigrants and Black and Hispanic residents, who are often at higher risk of contradicting STDs because they are more likely to lack insurance and lack access to health care, said Makella S. Coudray, a postdoctoral scholar in the Department of Population Health Sciences at the University of Central Florida who studies sexual health disparities among marginalized populations.

"Orlando is primarily a minority community," Coudray said. "They're inherently at an increased risk."

Minorities, particularly Black individuals, are also less likely to trust the medical system to take care of them due to decades of systemic discrimination, Coudray said.

This is punctuated by incidents such as the Tuskegee syphilis study during which Black men with syphilis were denied penicillin treatment to study the natural progression of the disease. The study, administered without participants' informed consent, began in the 1930s and ended in 1972 only after it received negative press.

Central Florida also is one of the areas most affected by the state's opioid epidemic, Roberts pointed out. Multiple studies have connected drug use to a higher risk of contracting a sexually transmitted disease. Syphilis is also primarily spreading among young people in their teens, 20s and 30s, and Orange trends younger than most Florida counties.

"You have a perfect storm in the Orlando area," Roberts said.

What can be done?

The Florida Department of Health in Orange County did not respond to questions from the Orlando Sentinel about what factors might be affecting the county's syphilis rates, whether Orange has updated its STD prevention strategy in response to the increase, or how the county is faring given the national shortage of penicillin, caused by increased demand due to rising STD rates, according to the drug's manufacturer, Pfizer.

Outside experts say the epidemic requires increased access to care for these vulnerable populations. The health department offers treatment for free or low cost, as do other organizations. But more than that, it requires education.

It is easier to get diagnosed and treated in Orange County than in rural areas of the state, but there's not enough public knowledge about how often someone should test and what resources are available, said Daniel J. Downer, executive director of the Bros In Convo initiative.

"Stigma is very real and can prevent individuals from wanting to even get tested before they even know what their status is," Downer said. "There are other individuals who aren't engaging at all because they're afraid that this is going to cost them money."

Coudray linked the stigma to a larger national attitude.

"The U.S. response to STIs has largely been at the individual level, and promoting individual prevention strategies like condom use. However, that has inherently promoted stigma and perpetuated an atmosphere of shame when it comes to STI infection," Coudray said.

The Black, queer-led grassroots Bros in Convo Initiative offers free confidential walk-in testing, with referrals to CAN Community Health if a positive test occurs. Hours are available on the initiative's website.

Places like The Center, a local LGBTQ hub, also offer free, confidential walk-in testing at Orlando and Kissimmee sites, with hours available on the organization's website.

Free or income-based walk-in testing is also offered at a range of other places, including Harmony Healthcare Orlando, a nonprofit focusing on providing PrEP, Hepatitis C, and HIV treatment.

2024 Orlando Sentinel. Distributed by Tribune Content Agency, LLC.