Karolyn Schrage runs the Choices Medical Services clinic in Joplin, Missouri, where a normal day for her includes several patients of all ages seeking treatment for syphilis. According to The Daily Beast, Schrage can barely keep enough of the sexually transmitted infection's antibiotic treatment, penicillin G benzathine, stocked on the shelves before more patients come.
According to public health officials, rural counties in the Midwest and West are becoming new challenges to combat the spread of syphilis. While it is still concentrated in urban areas like San Francisco and Atlanta, its prevalence in areas across Missouri, Kansas, and Iowa are equally, if not more, concerning. People living in rural areas tend to have lower levels of access to public health resources, less experience with the disease, and lower willingness to address the problem because of conservative attitudes towards nonmarital sex and homosexuality.
The total number of syphilis patients in Missouri has grown by over 400% since 2012, increasing from 425 cases in 2012 to 1,896 in 2018, a Kaiser Health News analysis reports. And while only 22 percent of total cases in 2012 occurred outside of metropolitan areas, over 44 percent occurred in rural areas in 2018.
At Schrage's clinic, she has seen the caseload skyrocket from five cases in the first quarter of 2018 to 32 in the same period in 2019 alone.
“I’ve not seen anything like it in my history of doing sexual health care,” she said.
Since 2003, federal funding for STD prevention has remained relatively flat, with $157.3 million in funding in 2018. But, according to the National Coalition of STD Directors, this corresponds with a nearly 40% decrease in purchasing power over the past decade in a half. Even though the number of cases in Missouri has quadrupled, funding for the state's CDC has decreased by 17% over the past 6 years. Other rural states like Iowa have exhibited the same trend in funding.