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SIOUX FALLS, S.D. (AP) - South Dakota Department of Health officials say the number of syphilis cases reported in the state last year was the most in 44 years.

State epidemiologist Lon Kightlinger labeled as "very disheartening" an annual summary of infectious diseases in South Dakota showing that 48 syphilis cases were reported in 2013.

"Through most of the 1990s and the 2000s, we didn't have any or one or two cases in a year," Kightlinger told the Sioux Falls Argus Leader (http://argusne.ws/1mkcf2O ).

The most reports of the sexually transmitted disease were in the Sioux Falls area, the largest population area in the state, with 23 cases, and Corson County, where the Standing Rock Reservation is located. Standing Rock reported 14 cases.

The Sioux Falls cases involve mostly men, and the Corson County cases both men and women. Kightlinger said people coming to Sioux Falls and having anonymous sex are largely responsible for the spread of the disease in the state, and Corson County represents the disease going through a specific population.

"Somebody goes someplace, gets syphilis and brings it home," he said. "They're having sex with somebody at home, and it's not recognized right away. That person has sex. It's like a spider web."

The Standing Rock Reservation straddles North and South Dakota.

Kightlinger said health officials are particularly worried about the syphilis increase because unlike some other diseases where outbreaks can be controlled by eliminating specific sources of contamination, "there's so much personal choice involved."

Left untreated, the disease can affect the liver, nervous system and brain, and it can be transmitted by pregnant women to their fetuses.

Sioux Falls public health officials said they would be looking at grant funding to deal with disease outbreak prevention.

"If we know a disease is in the community, it provides us an opportunity to drive an education program," Sioux Falls public health manager Sandy Frentz said. "It's part of the picture of overall community health. How can we impact community health through prevention and education?"

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