photo courtesy of Ron Lach on pexels.com
MONTGOMERY, Ala. —The Alabama Sexually Transmitted Diseases (STD) report from January 2021 to March 2025 shows steady increases in syphilis across multiple counties, including prisons, according to the Alabama Department of Public Health.
The increase in syphilis cases in Alabama prisons isn’t subtle, says ADPH officials.“We have seen an increase in the number of syphilis cases,” said Thomas. Thomas said crowded living spaces, limited prevention access and difficulty completing treatment make prisons an easy place for syphilis to spread.
Those issues follow people into prison and follow them back out. “Some inmates get transferred or released without our knowledge,” Thomas said. This makes it easy for someone to leave custody before getting their results or completing treatment.
“Some areas in Alabama, especially in the Black Belt have no or few health care clinics they usually have to travel long distance to access care. Some are without transportation or lack the funds to secure transportation, which in turn contribute to the spread of STDs,” said Beverly Thomas ASA III and office manager with the ADPH STD Division.
Another ADPH leader confirmed Thomas’s concerns, saying many inmates are released or transferred before their results come back. Anthony Merriweather, director of the ADPH STD Division, said if an inmate is released before their results are in, “this increases the possibility of community spread.” Merriweather also said the Alabama Department of Corrections (ADOC) does not currently have a formal plan to reduce sexually transmitted infections (STI) or HIV. “Testing is offered but it’s optional,” he said. However, he did point to one solution outside of prisons, which is consistent sexual health education in Alabama schools. Comprehensive instruction beginning in middle and high school could significantly reduce sexually transmitted infection rates statewide, he said.
State data shows Alabama’s STD burden is still growing
Statewide data from ADPH shows how fast cases have climbed over time. For instance, there were 1,251 cases in 2018, 1,630 in 2019, 2,124 in 2021, 3,046 in 2022 and 3,341 in 2023.
These numbers resulted in showing that there was a 167% rise since 2018, bringing Alabama’s rate to 65.8 cases per 100,000 people, according to ADPH. This sharp rise shows how quickly syphilis is actively spreading across the state. For example, rural counties, especially in the Black Belt, continue to show higher rates, reflecting the same access issues Thomas described. Also, the Centers for Disease Control and Prevention is sounding the alarm about antibiotic overuse. For instance, the CDC has launched several campaigns about the dangers of antibiotic misuse, including the national “Be Antibiotics Aware” initiative. In addition, according to the CDC, unnecessary antibiotic use contributes to resistance and makes infections harder and more expensive to treat.
Staffing shortages make everything harder
According to Thomas and Merriweather, one of the biggest obstacles is inconsistent medical staffing inside the Alabama Department of Corrections facilities. After asking, Thomas said she believes that the facilities need “More permanent staffing, which will allow testing to be on a more consistent basis.” Thus, allowing infections to be detected early and preventing their spread. She also stated, “Rapid Testing, especially before release, is another major need. Without it, untreated syphilis easily moves between prisons and the community.”
Despite these challenges, Merriweather said ADPH and ADOC maintain a “collaborative relationship.” ADPH trains staff, coordinates screenings and provides educational materials but neither denies that rural health care shortages continue to affect prevention efforts statewide. However, treating syphilis has its own environmental connection.
Antibiotic treatment carries environmental costs
As syphilis cases have been rising since 2018, so has the use of antibiotics and that’s where environmental concerns come in. A 2020 review in Med Pharm Rep by Svetlana Iuliana Polianciuc, Anca Elena Gurzău, Bela Kiss, Maria Georgia Ștefan and Felicia Loghin explained how antibiotics from human and veterinary medicine enter the environment through wastewater, soil, sewage sludge and even crops.
The authors report antibiotics have been detected in: surface water, groundwater, drinking water, soil and vegetables. They note these medications are “persistent or pseudo-persistent,” meaning they enter the environment faster than they break down. As they accumulate, they can contribute to the growth of antibiotic-resistant bacteria, which can eventually make their way back into humans. Even proper use leads to environmental release but improper disposal, like flushing leftover pills, makes the problem worse.
Antibiotics are active even after disposal
But behind the immediate public health concerns, ADPH researchers say another problem is quietly building an environmental impact of the antibiotics used to treat these infections.
Interviews with ADPH officials, combined with the 2020 Romanian study, showed how increased antibiotic use contributes to pollution in water, soil and plants. The findings add to the environmental crisis affecting Alabama communities, both inside and outside prison walls.
Antibiotics come in several groups, and each behaves differently once it enters the environment. According to the Med Pharm Rep report, Tetracyclines tend to remain in the gastrointestinal tract and are often excreted unchanged, while macrolides can linger in soil for five to 120 days.
Fluoroquinolones are harder to break down and can build up in soil and sediment, where they have been linked to genetic damage in aquatic species. Penicillins and cephalosporins break down more quickly but they can bind to minerals and accumulate in sewage sludge, contributing to bacterial resistance in wastewater treatment plants.
Additionally, these researchers observed several environmental effects, including problems with plant photosynthesis and growth, damage to DNA in soil organisms, disruption of natural microbes, buildup in aquatic animals, and breakdown products that can be more toxic than the original medication.
To be clear, these findings don’t mean syphilis medications are uniquely harmful. Instead, researchers say they show that all antibiotics, when used widely, eventually create environmental challenges.
A crisis that needs attention
Alabama’s rise in syphilis isn’t happening on its own. Inside prisons, understaffing, optional testing and limited access to medical care contribute to infections spreading. Outside those walls, rural communities still deal with long drives, few clinics and long wait times, all of which delay testing and treatment. And as more people need antibiotics, more of those drugs eventually enter the environment. Additionally, the research from Polianciuc and her co-authors showed that increased antibiotic use adds to long-term ecological damage and fuels the global problem of antibiotic resistance. Thomas and Merriweather say the immediate needs are clear: consistent medical staff, faster testing before people are released, stronger rural healthcare systems, and real sexual health education for students.
Alabama’s syphilis crisis isn’t just a medical issue but it’s an environmental one too, according to the ADPH data. The issue shows how tightly connected health care, rural inequality and environmental protection really are and until those gaps are addressed, the cycle will continue.
