Syphilis outbreak reported in Santa Cruz County

SANTA CRUZ — Public health authorities have reported a syphilis outbreak in Santa Cruz County after several cases were identified in the South County region.

According to a public health advisory addressed to the county’s health care providers and uploaded to the county Health Services Agency’s website March 14, several cases of syphilis were identified in the city of Watsonville in late February, primarily among individuals experiencing homelessness.

As of March 14, eight probable cases had been identified along with 10 suspect cases and nine case contacts that suggest a potential for more.

The advisory comes amid a separate bacterial outbreak that officials have been battling since January. As of Monday, 37 cases of shigellosis had been confirmed, primarily in the North County region, also among individuals experiencing homelessness. A shigellosis infection often includes diarrhea, stomach pain/cramps or fever and is easily spread, particularly in environments with limited hygienic infrastructure.

Syphilis, according to the advisory, is a sexually transmitted infection caused by the bacterium Treponema pallidum and, if left untreated, it can spread to the brain and nervous system. An infection during pregnancy can carry significant adverse outcomes, including fetal death.

County Public Health Officer Lisa Hernandez wrote in the advisory that the outbreak is especially concerning, given that there is an ongoing national shortage of Bicillin L-A, the brand name for penicillin, the antibiotic used to treat syphilis.

Syphilis is often referred to as “the great pretender,” as symptoms often look similar to other diseases and can follow a progression of stages that can last weeks, months or even years. The first or “primary stage” of the illness may include a single or multiple sores, also known as a “chancre,” that are usually firm, round and painless and often appear in or around the genitals, rectum, anus, lips or mouth. The sores last three to six weeks and heal regardless of whether a person receives treatment, according to the advisory, but if no treatment is received, the infection will progress.

Subsequent stages include continued spread of rashes or sores, a latent stage with no obvious indications or symptoms and a final “tertiary stage” that can impact the body’s major organs such as the heart and brain.

Consequences for a baby born to a person with syphilis, or congenital syphilis, can also have serious consequences such as a miscarriage, premature birth or stillborn birth.

According to the advisory, syphilis cases have been increasing in the county at a concerning rate in recent years. In 2022, 120 primary, secondary and early latent cases were reported to Santa Cruz County Public Health, which is more than double the 2020 total. Last year, 85 cases were reported, with 36%, or about 30, occurring among people experiencing homelessness and 32%, or about 27, who were female, according to the advisory. No congenital syphilis cases have been reported since the three that were documented in 2022.

According to the advisory, individuals are at risk of contracting syphilis if they are sexually active and are at higher risk if they:

• Engage in high-risk sexual activity such as having sex without a condom, having multiple sexual partners, having anonymous sex, and/or having sex while using drugs.

• Have HIV or other sexually transmitted infections.

• Are taking pre-exposure prophylaxis for HIV prevention.

• Have partner(s) who have tested positive for syphilis.