Rural communities where people have less access to healthcare and more conservative attitudes towards sex may be fuelling a rise in syphilis, experts warn.
More than 101,000 people in the US were diagnosed with syphilis in 2017 and officials have raised concerns about a resurgence in the UK and Australia, too.
Figures have suggested the use of heroin and methamphetamine are driving up syphilis rates in the US, but where people live may also be a factor.
In small towns people might be afraid of seeing a doctor they know personally, or doctors who have never seen syphilis before may struggle to diagnose it, experts suggest.
The state of Louisiana was worst affected by syphilis in 2017, followed by Nevada and California. The least affected areas were Wyoming and Alaska
Karolyn Schrage, director of a medical clinic in Joplin, Missouri, said she saw 32 cases of syphilis in the first quarter of this year, up from just five in early 2018.
‘I’ve not seen anything like it in my history of doing sexual health care,’ she told Kaiser Health News.
‘It really is astounding to me that in the modern Western world we are dealing with the epidemic that was almost eradicated,’ she added.
In the state as a whole, the number of syphilis cases has risen from 425 in 2012 to 1,896 in 2018.
A disproportionate amount – almost half – are happening outside of the cities of Kansas City and St Louis, in more rural areas.
Experts believe this could be because people in the country have less access to healthcare, less knowledge of sexually transmitted diseases, and potentially more conservative opinions on sex outside of marriage or gay sex, KHN reports.
And, in small towns, people’s embarrassment may be made worse by having to see a doctor who is also their Sunday school teacher or knows members of their family.
Doctors who haven’t seen syphilis before – even the total 101,567 cases in the US is still only around 0.03 per cent of the population – may not even recognise it.
Cuts to healthcare funding only add to the difficulty medics face in stopping the infection, according to Craig Highfill, director of HIV, STD and hepatitis prevention in Missouri.
He said funding from the Centers for Disease Control and Prevention (CDC) is more thna $354,000 (£272m) less than it was in 2012, even though syphilis cases have quadrupled.
George Walton, an STD program director in neighbouring Iowa, told KHN: ‘It is very difficult to get ahead of an epidemic when case counts are steadily – sometimes rapidly – increasing and your resources are at best stagnant.
‘It just becomes overwhelming.’
A report released last year by the CDC said injectable heroin and meth are driving up ‘staggering’ rates of syphilis.
Between 2013 and 2017, the rate of high-risk, transmissible syphilis in the US soared by 73 per cent.
In the same period, the number of people who had syphilis and reported using the injection drugs meth and heroin more than doubled, according to the CDC report.
Syphilis is most often passed from person to person through vaginal, anal or oral sex.
In its early stages, syphilis causes sores to develop around the genitals and occasionally the mouth.
It’s easy to treat with a course of antibiotics – typically penicillin – if the medication is started early enough.
However, if syphilis is left untreated for too long, the infection can start to damage the brain and even cause paralysis or blindness. Babies can be born with syphilis if their mothers have the infection.