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State epidemiologists report sharp rise in syphilis cases, urge expanded rapid testing and partner services
Summary
State epidemiologists told the Fargo Cass Public Health Board that syphilis cases in North Dakota rose roughly 309% from 2020 to 2024; two‑thirds of recent infections are early stage, seven congenital cases have been reported in 2026, and officials urged expanded rapid testing, jail screening and partnerships to reach people who use drugs.
State epidemiologists told the Fargo Cass Public Health Board on June that North Dakota has seen a marked increase in reported syphilis cases and outlined immediate steps the department plans to take to expand testing and outreach.
Brenton, an epidemiologist with the North Dakota Department of Health and Human Services, said the state recorded "about a 309% increase in the number of reported syphilis cases from 2020 to 2024," and that early 2026 counts showed an ongoing rise. "As of our June update, we have had about 126 cases in North Dakota," he said, adding that two out of three cases are early‑stage infections indicating active transmission.
Why it matters: early‑stage syphilis is infectious, and a rising share of cases among women has accompanied an increase in congenital infections. "We've had seven cases of congenital syphilis in North Dakota as of today," Brenton said, and he told the board most affected mothers in recent cases had limited or no prenatal care.
Treatment and supply constraints: presenters warned that the recommended first‑line treatment, benzathine penicillin (Bicillin), is in short supply. "We are constantly and consistently in a Bicillin shortage," the presenter said, noting manufacturers have signaled shortages extending into next year, which complicates efforts to provide three weekly doses when required.
Planned actions and outreach: epidemiologists urged rapid syphilis testing at nontraditional sites and stronger partnerships with community programs. Recommendations included adding point‑of‑care rapid tests (15–20 minute cartridges) in clinics and syringe service programs, expanding jail screening so people can be treated while incarcerated, and conducting public health detailing and clinician training such as Project ECHO to increase provider comfort with treatment.
Case investigation and partner services: Jenna (epidemiologist) described case investigation procedures: once a case is confirmed, staff generally attempt same‑day contact, follow up with alternate phone numbers and letters, and coordinate with local partners such as Fargo Cass Public Health to locate patients. She described difficulties reaching people who lack stable contact information.
Local counts and demographic shifts: Brenton said Cass County had 32 cases in the first five months of 2026 compared with 61 cases for all of 2025 in that county, and noted an increasing share of diagnoses among Indigenous populations and an uptick in female cases, which public health officials linked to the rise in congenital infections.
Next steps and public guidance: presenters said they will issue health alerts to emergency departments and providers requesting more routine syphilis screening in ER and urgent‑care settings, increase rapid testing pilot programs, and pursue outreach to people who use drugs and to correctional facilities. The board was advised these efforts aim to improve case finding and reduce missed screening opportunities among pregnant people.
The Board did not take a formal vote on new policy during the meeting; staff described proposed operational steps and planned communications to local providers and community partners.
