MYRTLE BEACH, S.C. (WBTW) — South Carolina, already one of the nation’s top places for chlamydia and gonorrhea infections, might be about to see a boom in syphilis cases.

“Syphilis is something that is very concerning to us,” said Beth De Santis, the CEO of Fact Forward, an organization that aims to reduce the rate of sexually transmitted infections and teen pregnancies in South Carolina.

The state ranks fourth-highest in the nation for its rate of chlamydia, with 34,118 cases in 2020 adding up to a rate of 662.7 diagnoses per 100,000 people in 2020, according to data from the U.S. Centers for Disease Control of Prevention. It ranks third for gonorrhea cases, with 16,705 in 2020 creating a rate of 662.7 diagnoses per 100,000 people. 2021 data is not yet publicly available.

The real rate is likely higher, the CDC says, due to health facilities shutting down in the early months of the pandemic, which led to fewer people being tested. The “picture remains very unclear,” a report from the CDC warns, and the impact might continue for several more years.

“What is clear, however, is the state of STDs did not improve in the United States,” the report on the pandemic’s impact on STI data reads. “Prevention and control efforts remain as important as ever.”

While 2020’s numbers show an overall drop in chlamydia and gonorrhea, that is only reflected in data after March 2020. Prior to then, each month saw more cases than compared with the same timeframe in 2019.

Syphilis testing, however, was still a priority in medical offices. South Carolina ranked a hair better than the rest of the nation in its rate that year with 652 cases and a rate of 12.7 diagnoses per 100,000 people.

But when it comes to preliminary 2021 data, the CDC has highlighted an alarming trend. Data shows that nationwide, syphilis in newborns was up 6% from 2020. There were 34% more cases in women and 9% more in men.

By the time those case counts appear, De Santis said it means that the infection has already been spreading within a community for a long time. On one hand, she said, the diagnosis means that the STI has been detected and doctors are able to treat it.

“But then the other lens is, ‘Oh, Lord, we’re not treating it in a way that’s bringing it back down,’ and so that is where we are now,” she said.

STIs disproportionately affect women. Because women are less likely to have symptoms — or mistake them for a yeast infection — the infections are more likely to be detected late. And even though women visit the doctor more than men, they often have to ask to be tested for an STI, because testing isn’t always part of an annual exam.

If untreated, syphilis can cause infertility and even death. Two South Carolinians died from the infection in 2020, according to data from the South Carolina Department of Health and Environmental Control.

Syphilis is harder to test than chlamydia and gonorrhea, De Santis said, and people tend to stay away from blood draws. Infections will spread until they’re stopped, which means it will take longer to stop the increase in syphilis numbers.

The Pee Dee, especially, sees increased rates of STIs. Dillon County and Marion County have the second and third highest rates in the state for syphilis, and Dillon County has the highest gonorrhea diagnosis rate. 

De Santis said people don’t realize how common STIs are in the 15- to 24-year-old population, which is the age group with the most infections. 

Halting the spread, she said, relies on a three-pronged, educational approach. 

“We teach them how to brush their teeth, we teach them how to drive a car, we teach them how to put their seatbelt on,” she said. “We teach them how to cook, but if you think about it, there’s very few people in this world teaching young men or young women how to apply a condom correctly.”

The teen pregnancy rate has dramatically dropped within the last two decades — but STIs continue to rise. What’s happening, she said, is that more teens are using contraception, but only barrier methods like condoms can work to prevent infections.

Teens haven’t been using condoms during sex, according to results from the South Carolina 2019 Youth Risk Behavior Survey. 

About 37.4% of high school students 15 or older have had sexual intercourse, according to the survey, and about half of high school juniors reported that they have had sex.

Within the last year of taking the survey, 76.5% of teens had not been tested for an STD other than HIV, such as chlamydia or gonorrhea. 

De Santis said a few factors go into teens’ decisions to not use a condom. 

“One is that they haven’t been ready and available in the moment,” she said. “Adolescents are impulsive humans. Their brain is going too fast, and their actions are going so fast, and they really don’t have any brakes.”

Youth have to be conditioned to stop and not have sex if there isn’t an available condom, she said, and there need to be more access points to obtain one. They also need to learn how to correctly use a condom.

She said parents should be trained on how to be an “askable adult” and lead difficult conversations that include medically accurate information, which isn’t a one-and-done process.

And, finally, the medical community needs to take steps to prevent the spread. De Santis said doctors need to understand how rampant STIs have become and ask every person within the 15- to 24-year-old age group if they are sexually active — and if they’re not, if they are willing to be tested. If a teen is in a room with a parent who doesn’t know they’re sexually active, then a health care professional needs to spend alone time with the teen to ask those questions. If the teen is sexually active or plans to be, then doctors should talk about safety and the full array of contraceptive options.

Still, there’s barriers. Men who have sex with other men, for example, might not want to say that’s the type of sex they’re having, because they might not want to identify as a gay man, De Santis said. 

Efforts can be difficult in a conservative state where people will tell teens to stay abstinent until marriage, according to De Santis. While that is the best way to stop STDs and unintended pregnancies, communities need to do more.

“The reality is that that’s not what’s happening with our young people, and so we need to meet our young people where they are, and the stigma of being in a conservative state, without the resources for a young person to learn at home, in the schools, and throughout the medical community, I think, is playing out in the numbers right now,” she said.