A resurgence of monkeypox is underway in Chicago, raising the specter of another outbreak that alarmed public health officials and sent gay men and other at-risk residents scrambling for a limited supply of vaccines last summer.
Earlier this month, the city had the highest weekly rate of new mpox cases compared to New York and California, which have historically been hotspots for the virus in the U.S., according to a spokesperson with Howard Brown Health, one of the largest LGTBQ+ health care providers in the Midwest.
At least seven new cases of the virus, which can cause flu-like symptoms and rashes, have been reported since April 17, according to Howard Brown. In the three months prior, only a single case had been identified in Chicago. Some of the new cases were reported among people who were previously vaccinated against the virus.
This slight uptick is a worrisome indicator, according to Howard Brown spokesperson Wren O’Kelley.
“We’re coming into the summer where all of these social events and festivals and Pride happens, so we want to be very ahead of the curve on this to hopefully prevent any kind of larger outbreak from happening,” O’Kelley said.
Mpox quickly grew into a public health threat last year in Chicago and across the nation. At the outbreak’s peak, more than 140 cases were reported in Chicago in a single week in July.
The trend coincides with a recent assessment from the Centers for Disease Control and Prevention that described the national rates of sexually-transmitted diseases as a continuing “epidemic.” In April, the CDC announced that “sexually transmitted infections (STIs) chlamydia, gonorrhea, and syphilis all increased between 2020 and 2021 – reaching a total of more than 2.5 million reported cases,” according to its nation-wide surveillance data.
Experts see the two problems as intertwined. Monkeypox, now known as mpox, primarily spread through sexual or intimate contact last year among men who have sex with other men, according to the Chicago Department of Public Health. Those individuals are also at high risk of contracting an STD.
In Chicago, known cases of gonorrhea, chlamydia and syphilis have been rising in recent years. Thousands of Chicagoans are infected each year, with rates highest among gay and bisexual men and Black and Hispanic residents, city data show.
And it’s common for people diagnosed with mpox to also have an STI. According to the CDC, 41% of mpox patients reported an STD in the prior year.
For much of the past two decades, cases of chlamydia have been on a steady incline. Roughly 27,400 cases were reported in 2021, compared to about 25,300 in 2010, according to reports from the city’s Department of Public Health. The number of infections hovered around 19,800 in 2000.
Cases of gonorrhea climbed to more than 13,400 in 2021. In 2010, the city reported nearly 7,900 infections, according to reports from the city’s public health department.
And cases of primary and secondary syphilis rose from under 300 cases in 2000 to almost 800 in 2021, city data shows.
“When you look at the numbers of new cases that we’re seeing … the numbers are telling us that clearly this is not under control,” said Dr. Aniruddha Hazra, medical director for UChicago Medicine’s Sexual Wellness Clinic and director of STD services for the Chicago Center of HIV Elimination.
Health experts say STD rates have long been a low priority, yet their rising numbers across the nation highlight just how much attention the pandemic consumed from health care workers.
In Chicago, STD rates dipped shortly after the pandemic upended society in early 2020.
But this decline is the result of limited access to clinics and testing, and the actual number of cases was likely higher, health experts say. Many clinics either temporarily closed or implemented COVID-19 protocols that created more barriers to testing.
“The pandemic stopped people from seeking care for the first two waves [of the virus] where people just didn’t come to the clinics because they worried about COVID,” Hazra said.
Health experts say it could take years to recover ground lost during the pandemic and get infection rates back to pre-pandemic levels. Some health providers say screenings are still down compared to 2019.
“We’re just starting to get a lot more people back into our clinics as we’ve loosened a lot of our COVID protocols,” said Kunal Bakshi, the medical director of Howard Brown Health at Thresholds South.
City health officials are particularly concerned about the rise of syphilis among pregnant women. Thirty-five pregnant women were diagnosed with syphilis last year, up from just nine cases reported in 2019, according to records from the Chicago Department of Public Health.
Mothers can pass on the infection to their babies and without proper treatment, syphilis can lead to the death of the child or create health problems like deafness and blindness.
Dr. Allison Arwady, Chicago’s top public health official, recently highlighted the case of a Black woman in her 20s who was not properly screened for STDs. When she went into labor, the woman gave birth to a stillborn baby.
“This should never happen,” Arwady said during one of her regularly scheduled Facebook live events. “We should never have a woman give birth in the city of Chicago who has not been tested and treated for syphilis.”
The rise of STD rates has also further highlighted inequalities in access to health care.
Hazra from UChicago said the city’s South and West sides see the most exposure to STDs but are the most under-resourced areas when it comes to screening and medical treatment.
“Chicago is definitely doing something,” Hazra said. “But it’s clearly not enough, right? If we’re seeing ongoing rates continuing to increase, particularly in ZIP codes on the South and West sides of Chicago, then clearly whatever screening we’re doing is not enough.”
Arwady said Black and brown Chicagoans in low-income communities are less likely to have medical insurance or a primary care provider where they can routinely get tested.
“This is where we’re working hard to make sure that people can be insured, even if they’re low income. Especially on the South and West sides,” Arwady said. “But I think there is a well-deserved lack of trust in terms of how Black and Latino people may have historically been treated by the medical profession. There’s a long history of systemic racism there. And we know that those people are often more hesitant to seek treatment.”
Bakshi at Howard Brown Health said their clinics have been using the antibiotic doxycycline to prevent syphilis, particularly in patients who may have been infected several times. The drug is already used to treat a range of infections, Bakshi said, and it is normally covered by insurance.
In response to the national spike in infections, the Centers for Disease Control and Prevention is drafting recommendations for using doxycycline as a kind of morning-after pill for preventing STDs, the Associated Press reported last month.
There’s also the syphilis elimination task force that the city’s public health department put together in 2019.
Hazra from UChicago, who is a part of the task force, said they’re working on educating providers on how to properly treat STDs. They are also advocating for more funding to address the ongoing STD epidemic.
But because STDs have been a low public safety priority for decades, Hazra said they “remain to be largely ignored in terms of funding and resources that are diverted to them.”
“We can’t solve a problem that we don’t commit to actually fixing. And that comes in the form of dollars,” Hazra said.
Anna Savchenko is a reporter for WBEZ. You can follow her on Twitter @annasavchenkoo.