In Region 5 (Carroll, Coshocton, Harrison, Holmes, Jefferson, Stark, Tuscarawas and Wayne counties), there was a 45% increase in infectious syphilis cases and a 200% increase in congenital syphilis cases during 2021
(On a personal note...I spent about 90 days in Coshocton in 2011 for business. Quiant little place. Home to the Applebutter Festival (with old time Amish horseshoeing and everything.) BUT!!!!! I noticed something strange. The physical appearances of many people. Large foreheads, protruding brows, limbs oddly short compared to the trunk/core of their bodies, etc. Deep-set dark eyes. I was perplexed. So I went to the little library. The librarian was exstatic to take me to the archives room. And to tell me all about the inbreeding. Yep. It isn't as simple as incest, it's decades/century old family members playing loose and fast with impunity. Not really knowing who is related to who and how. I still feel wide-eyed just thinking back to what I learned. My 5th trip in to delve further was met with a sign on the archive room door, "Closed for maintenance." I guess someone noticed me noticing. And now we all know, they've got syphilis, as well.)
Wow! Of course inbreeding in remote rural areas was fairly common. When your only transportation is a horse (if you’re lucky) and the nearest village is a day or more ride away, you hookup with whomever is close. Family members, children of family members, basically anyone you can get. I found a family history book with some close relatives marrying. The original patriarch of my dad’s family was married to his niece when they migrated from Germany.