Syphilis is surging in New Mexico. According to the Centers for Disease Control and Prevention, the state is now ranked second-highest nationally for the rate of syphilis cases; and, it is number one in the rate of congenital syphilis cases, a sexually transmitted infection that is passed from a pregnant woman to her unborn child.
The rise has been swift and alarming: cases of congenital syphilis have increased nearly ninefold in five years, with devastating consequences such as preventable infant deaths. In response, the New Mexico Department of Health has renewed a public health order to increase screening and testing among pregnant people and pivoting to screening all sexually active adults based on age, rather than risk factors (which often isn’t reported to health care providers).
The New Mexico Syphilis ECHO program is working to address this crisis by equipping public health providers—especially those in rural and underserved communities—with the knowledge and resources to diagnose, treat and prevent syphilis. By expanding access to expert-led training and fostering a collaborative network of care, Project ECHO is strengthening the state’s response and ensuring that providers across New Mexico and the United States are prepared to meet this growing public health challenge.
Rural communities, including Roswell, New Mexico (above), face significant challenges in managing syphilis. Photo Credit: Adobe Stock
For public health professionals Maxine Simons and Audra Chavez, in the Southeast public health region of New Mexico, the Syphilis ECHO program has transformed their approach to syphilis intervention, from case investigation to patient education and outreach. Through interactive learning, case studies and real-world applications, the program has enhanced their ability to provide timely, effective care.
Addressing Rural Health Care Barriers
Rural communities in New Mexico face significant challenges in managing syphilis, including a shortage of providers, limited access to treatment, and gaps in routine screenings for sexually transmitted infections. Many hospitals lack the capacity to diagnose and manage congenital syphilis, often requiring infants to be transferred out of state—an added disruption that complicates follow-up care and case-based surveillance.
Audra Chavez, disease prevention supervisor for the Southeast part of the state, notes that provider shortages and a lack of awareness with syphilis guidelines are major barriers to effective care.
New Mexico state public health professionals Maxine Simons and Audra Chavez. Photo Credit: New Mexico Department of Health, February 2025.
“Many providers, both in public health offices and private clinics, aren’t comfortable staging syphilis, which involves determining the infection’s progression based on symptoms and test results. Others struggle to access bicillin, a long-acting penicillin used as the first-line treatment for syphilis, due to cost,” Chavez explains. “The Syphilis ECHO program has been invaluable in bridging these gaps, expanding our knowledge, and equipping us with strategies to ensure patients receive appropriate care.”
Through Project ECHO, rural health professionals gain the training and resources they need to diagnose and manage syphilis with greater confidence. One critical tool emphasized in the program is the syphilis titer grid, which tracks antibody levels to assess disease progression, treatment response and potential reinfection. In many rural settings, providers may have limited experience interpreting these fluctuations.
A titer reactor grid used to measure antibody levels in syphilis diagnosis. Photo Credit: The Centers for Disease Control and Prevention.
“The ECHO sessions provide real-world case studies that directly inform our investigations,” adds Maxine Simons. She works at an advanced level as a disease intervention specialist, one of the “disease detectives” who help stop the spread of sexually transmitted infections. “Learning to use the syphilis titer grid has been a game changer. It helps me track disease progression with confidence, ensuring patients and providers understand what’s happening and receive timely, appropriate treatment.”
Applying ECHO Knowledge to Real-World Cases
One of the most valuable aspects of the Syphilis ECHO program is the ability to learn from case studies and apply those lessons directly to patient care. Simons and Chavez have seen firsthand how insights gained from ECHO sessions have led to improved interventions.
Syphilis blood test, used for detecting Treponema pallidum, the bacteria that causes syphilis. Photo Credit: Adobe Stock
Chavez recalls a recent case in Clovis, where a newborn’s syphilis titer was found to be higher than the mother’s—a rare occurrence that had been discussed in a prior ECHO session.
“Because we had reviewed a similar case in the program, we were able to provide clear recommendations to the provider on how to proceed with treatment and evaluation for the baby,” says Chavez. “That kind of knowledge-sharing is invaluable in rural settings where we don’t always have specialists to consult immediately.”
Simons also emphasizes the importance of outreach strategies she’s learned through ECHO, particularly in reaching populations that would not typically seek STI testing. “Our mobile unit has been crucial in reaching individuals who wouldn’t normally come in for testing,” says Simons.
“Through Project ECHO, we’ve learned creative approaches to encourage patients to follow through with additional testing and treatment. In multiple cases, we’ve been able to link patients to care who might otherwise have been lost to follow-up.”
Strengthening New Mexico’s Public Health Response
The Syphilis ECHO program aligns closely with New Mexico’s public health priorities by expanding access to knowledge, improving disease intervention strategies, and ultimately reducing syphilis transmission rates. By equipping local providers with the tools and confidence to address syphilis cases, the program strengthens the state’s broader public health infrastructure.
As New Mexico continues to combat the syphilis epidemic, the Syphilis ECHO program serves as a crucial tool, empowering health care professionals with the knowledge and support they need. By fostering collaboration, enhancing clinical understanding, and improving patient outcomes, the program is driving meaningful progress in public health—one case at a time.
In March 2025, the New Mexico Syphilis Syndemic ECHO Program will relaunch, with a broader focus to encompass the socioeconomic conditions driving the infection’s resurgence, including substance use or psychological factors. Save your seat for this monthly no-cost telementoring series on iECHO.org.
The project is supported by grant number U3IRH43513 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS.
Featured image: Colorized electron micrograph of Treponema pallidum, the bacteria that cause syphilis. Photo credit: National Institute of Allergy and Infectious Diseases