AUGUSTA, Maine (AP) Public health officials in Maine say there has been an increase in syphilis cases, mirroring a national trend.

According to the Maine Center for Disease Control, the number of syphilis cases reported in the state increased from 48 in 2016 to 84 last year. The number of national syphilis cases increased by 18 percent in between 2015 and 2016.

Maine Department of Health and Human Services spokeswoman tells the Bangor Daily News the department isn’t sure why syphilis has increased in recent years. Portland Public Health Center medical director Dr. Christina DeMatteo believes opioid use and waning concerns about HIV have contributed to attitudes about having unprotected sex.

Public health advocates say budget cuts resulting in changes in prevention and treatment have also affected rates in the state.