Over the past several years the U.S., and especially the state of Mississippi, has seen an alarming rise in sexually transmitted infections (STI’s), with alarming consequences. The explosion of syphilis has given rise to a tragic increase in congenital syphilis, leading to documented infant deaths and numerous other cases of long-term disability, stillbirths, and miscarriages. Mississippi has seen the largest increase of any state, with a greater than 1000% increase in babies diagnosed with syphilis at birth. In addition to the increase in syphilis, we have witnessed similar increases in other STI’s such as chlamydia and gonorrhea. Rates of HIV infection, despite massive investment, have remained stubbornly high.
There are numerous factors contributing to these challenges, and consistent with other health issues, Mississippi is experiencing a greater burden than the rest of the country. Factors such as poverty, access to care, and inadequate (or non-existent) reproductive health education are all contributing to this public health crisis. Perhaps one of the greatest, most directly mitigatable factors, has been the erosion of and disinvestment in public health. The Mississippi State Department of Health, unlike almost every other state agency, has weathered unprecedented cuts in state funding. Recent state budget surpluses, directed to other agencies, have essentially bypassed public health in Mississippi. Local, county health departments represent but a shadow of their previous capabilities. Interrupting disease transmission in the community requires public health investigators to identify cases and ensure treatment of cases and contacts. In the 1990’s, when Mississippi experienced the last surge of syphilis, we had approximately sixty-five investigators dedicated to that purpose. Today we have slightly more than twenty. Our current situation is hardly surprising and was entirely predictable when, in 2016 and 2017, the legislature cut the health department’s state appropriation by more than thirty percent. Those cuts were never replaced.
Fortunately, the situation is not entirely bleak. Mississippi has a robust network of primary care clinics, community health centers and local health systems devoted to advancing the wellbeing of their community members. As outlined in this edition, modern therapeutic approaches, including HIV treatment and prevention (e.g., pre-exposure prophylaxis) give us tools to truly eliminate HIV transmission. The elimination of syphilis, and the prevention of congenital syphilis, are completely within our reach, given that a single treatment of intramuscular penicillin (sometimes three) can effectively cure the disease and prevent transmission. To be successful in these endeavors, the medical system must step up and take responsibility not only for individual patients, but also their respective communities. Identifying and treating syphilis saves lives and prevents downstream transmission. The early diagnosis and treatment of HIV leads to normal lifespans and blocks transmission of the virus. As Mississippi clinicians, we must all take responsibility for thinking about STI’s, making the diagnosis, and ensuring treatment. A critical element includes communicating cases of disease to the state department of health. Though understaffed, the agency is committed to growing its core workforce and prioritizing those at greatest risk (e.g., pregnant women with syphilis). Another necessary element is support from state leaders. We need commitment and financial support, or our public health infrastructure will continue to contract. Mississippi physicians have a powerful voice, and our advocacy will be absolutely essential if we want to improve the health of the state. Dedication to our shared public health endeavor is essential if we want to move Mississippi off the bottom of almost every health ranking. In the words of Dr. Daniel Edney, Mississippi’s State Health Officer, “change can’t wait.” I think we all agree.