State and local health departments across the U.S found out in June they’d be losing the final two years of a $1 billion investment to strengthen the ranks of people who track and try to prevent sexually transmitted diseases — especially the rapid increase of syphilis cases.

The fallout was quick: Nevada, which saw a 44 percentage-point jump in congenital syphilis from 2021 to 2022, was supposed to get more than $10 million to bolster its STD program budget. Instead, the state’s STD prevention budget went down by more than 75%, reducing its capacity to respond to syphilis, according to Dawn Cribb at the Nevada Division of Public and Behavioral Health.

Several states told The Associated Press that the biggest impact from having the program canceled in the national debt ceiling deal is that they’re struggling to expand their disease intervention specialist workforce. These people do contact tracing and outreach, and are a key piece of trying to stop the spread of syphilis, which reached a low point in the U.S. in 2000 but has increased almost every year since. In 2021, there were 176,713 cases — up 31% from the prior year.