Syphilis Rates Soar: The STIs Making a Comeback in the US
Public health officials are sounding the alarm regarding a statistic that seems like it belongs in a history textbook rather than a modern medical report. Syphilis, a sexually transmitted infection (STI) once thought to be near elimination, has returned with alarming velocity. Recent data released by the Centers for Disease Control and Prevention (CDC) indicates that syphilis cases in the United States have reached their highest numbers since 1950.
The Numbers Behind the Epidemic
The latest STI Surveillance Report from the CDC paints a stark picture of sexual health in America. While rates of chlamydia have remained relatively flat and gonorrhea has seen a slight decline, syphilis cases are climbing rapidly.
According to the data, total syphilis cases surpassed 207,000 in a single year. This represents an 80% increase since 2018. Even more concerning is the rise in the most infectious stages of the disease, known as primary and secondary syphilis. These stages alone accounted for over 59,000 cases.
The resurgence is not limited to specific pockets of the population. While gay and bisexual men continue to make up a significant portion of cases, rates are rising sharply among heterosexual men and women. This widespread increase suggests that the infection is circulating more freely in the general population than it has in decades.
The Tragedy of Congenital Syphilis
The most devastating consequence of this surge is the dramatic rise in congenital syphilis. This occurs when the infection is passed from a mother to her baby during pregnancy. The CDC reported more than 3,700 cases of congenital syphilis in the most recent annual data. This is roughly ten times the number seen just a decade ago.
Congenital syphilis can lead to severe health outcomes, including:
- Miscarriage or stillbirth.
- Premature birth.
- Low birth weight.
- Deformities of the bones.
- Severe anemia and brain/nerve problems.
The tragedy is that these cases are entirely preventable. Timely testing and treatment with penicillin during pregnancy can prevent transmission to the infant with a very high success rate. The rise in these numbers points to significant gaps in prenatal care and syphilis screening.
Why Is This Happening Now?
Experts point to a “perfect storm” of factors contributing to the breakdown in STI control.
1. Erosion of Public Health Infrastructure Funding for sexual health clinics has been stagnant or cut in many states over the last decade. Many clinics have reduced hours or closed entirely. This makes it difficult for people without private insurance to get tested and treated.
2. The Impact of the COVID-19 Pandemic During the pandemic, resources were diverted away from STI tracking to fight the virus. Additionally, many people skipped routine wellness exams where STI screenings typically happen. This allowed infections to spread undetected for months or years.
3. Changing Sexual Behaviors The use of condoms has decreased in some demographics. This is partly due to the success of PrEP (pre-exposure prophylaxis) for HIV prevention. While PrEP is incredibly effective at stopping HIV, it does not protect against syphilis, gonorrhea, or chlamydia.
4. Substance Use There is a documented intersection between the opioid and methamphetamine epidemics and the rise in STIs. Substance use can lead to riskier sexual behaviors and makes it harder for individuals to access consistent healthcare.
Recognizing the Signs: What to Look For
Syphilis is often called “The Great Imitator” because its symptoms can look like many other diseases. However, the infection follows a specific progression.
Primary Stage: The first sign is usually a single sore, known as a chancre. It appears at the spot where the bacteria entered the body. The sore is typically firm, round, and painless. Because it is painless and can be hidden in the vagina or rectum, it often goes unnoticed.
Secondary Stage: If untreated, the infection moves to the second stage. This is characterized by skin rashes (often on the palms of the hands and soles of the feet) and mucous membrane lesions. Other symptoms include fever, swollen lymph glands, sore throat, patchy hair loss, and fatigue.
Latent and Tertiary Stages: The latent stage has no visible signs. The bacteria remain in the body and can stay there for years. The tertiary stage is rare but destructive. It can occur 10 to 30 years after infection and damage the heart, brain, and other organs.
Treatment and New Prevention Tools
The good news is that syphilis is curable with the right antibiotics.
The Gold Standard Treatment Penicillin G benzathine remains the preferred treatment for all stages of syphilis. A single injection can cure a person who has primary, secondary, or early latent syphilis. Three doses at weekly intervals are recommended for individuals with late latent syphilis or distinct unknown duration. It is vital to notify sex partners so they can be tested and treated to prevent reinfection.
DoxyPEP: A New Prevention Strategy For populations at high risk, particularly men who have sex with men (MSM) and transgender women, a new preventive strategy known as DoxyPEP is showing promise. This involves taking 200 mg of the antibiotic doxycycline within 72 hours after unprotected sex. Studies have shown this can reduce the risk of acquiring syphilis and chlamydia by roughly two-thirds.
While DoxyPEP is a powerful tool, it is not a replacement for condoms or regular testing. It is a targeted intervention discussed between a patient and their healthcare provider.
Actionable Prevention Tips
Protecting yourself requires a proactive approach to sexual health.
- Get Tested Regularly: If you are sexually active, ask your doctor for a full STI panel. Do not assume they are running these tests automatically during a physical.
- Know Your Partners: Discuss testing status before engaging in sexual activity.
- Use Barrier Methods: Condoms and dental dams significantly reduce the risk of transmission when used correctly.
- Prenatal Care: If you are pregnant, confirm that your doctor is testing you for syphilis at your first prenatal visit. In areas with high prevalence, re-testing during the third trimester and at delivery is recommended.
Frequently Asked Questions
Is syphilis curable? Yes. Syphilis can be cured with the right antibiotics from a healthcare provider. However, treatment will not undo any physical damage that the infection has already caused.
How is syphilis transmitted? You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores can be found on or around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth.
Can I get syphilis again after being treated? Yes. Having syphilis once does not protect you from getting it again. Even if you have been successfully treated, you can be reinfected if you have sexual contact with someone who has the infection.
Is DoxyPEP available for everyone? Currently, CDC guidelines primarily recommend DoxyPEP for gay, bisexual, and other men who have sex with men, as well as transgender women, who have had a bacterial STI in the past 12 months. You should consult a doctor to see if it is appropriate for you.
Why are rates highest since 1950? The comparison to 1950 highlights a regression in public health control. After the introduction of penicillin, rates plummeted. The current spike is due to a combination of decreased public health funding, social stigma reducing testing, and changes in sexual network dynamics.