Syphilis Cases in the U.S. Are the Highest Since 1950

Diagnoses of the sexually transmitted infection rose by nearly 80 percent between 2018 and 2022, according to a new report from the CDC

A close-up black and white image of the bacteria that causes syphilis. It looks like a tangled shoe lace.
An image from an electron microscope of Treponema pallidum, the bacteria that causes syphilis. In 2022, the number of reported cases of syphilis in the United States was the highest it has been since 1950. Smith Collection / Gado / Getty Images

The United States saw more than 207,000 cases of syphilis in 2022, marking the highest number of cases in a year since 1950, according to a new report on sexually transmitted infections from the Centers for Disease Control and Prevention (CDC).

Compared to 2018, syphilis infections increased by nearly 80 percent in 2022. And cases of congenital syphilis—when an infected mother passes the disease to her baby during pregnancy—are also rising. Americans reported more than ten times as many cases in 2022 compared to 2012.

“We have long known that these infections are common, but we have not faced such severe effects of syphilis in decades,” Laura Bachmann, acting director of the CDC’s Division of STD Prevention, says in a statement.

Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if left untreated. During the primary stage of infection, people get sores around the infection site. Symptoms of the secondary stage include rash, fever, headaches, muscle aches and fatigue.

Without treatment, syphilis can spread to the brain and nervous system or lead to vision loss, hearing loss or paralysis. However, the condition can be cured with antibiotics that prevent the infection from progressing to later stages.

As cases have increased, they have disproportionately affected some racial and ethnic groups, according to the Department of Health and Human Services (HHS). Rates of syphilis were highest for American Indian or Alaska Native people and second highest for Black or African American people.

“The syphilis epidemic touches nearly every community, but some racial and ethnic groups bear the brunt because of longstanding social inequities,” Jonathan Mermin, director of the National Center for HIV, Viral Hepatitis, STD and TB Prevention at the CDC, tells the New York Times’ Apoorva Mandavilli.

The U.S. started tracking syphilis cases in 1941, and case rates declined dramatically in the 1940s and 1950s, likely because penicillin became more widely used as a treatment. But since 2011, cases have increased every year.

To explain the trend, experts pointed to a rise in substance abuse, reduced use of condoms and fewer sexual health clinics and other similar services at the state and local levels.

Even in places with national health care, “sexual health services remain inadequate relative to the need pretty much everywhere,” Jay Varma, a former deputy commissioner of health for New York City, tells the New York Times. “But it’s particularly a problem here in the United States.”

In 2022, cases of syphilis rose by 17 percent in the U.S. compared to the previous year, while cases of congenital syphilis rose by 31 percent. Just over 59,000 cases of primary and secondary stage syphilis were reported in 2022, a rate of 17.7 cases per 100,000 people.

But among the American Indian or Alaska Native population, there were 67 such cases per 100,000 people, and Black or African American people reported 44.4 cases per 100,000. One congenital syphilis case occurred for every 155 births in the American Indian and Alaska Native population in 2022.

South Dakota had the highest rate of infectious syphilis cases in 2022, more than double that of New Mexico, the state with the second highest rate, according to Mike Stobbe of the Associated Press (AP). An outbreak in the Native American community led to the increase, Meghan O’Connell, chief public health officer at the Great Plains Tribal Leaders’ Health Board, tells the publication.

HHS has established a National Syphilis and Congenital Syphilis Syndemic Federal Task Force to reduce infection rates. The task force will direct resources to places that have been impacted the most, promote health equity and engage with impacted communities.

The antibiotic used to treat syphilis—an injectable form of penicillin called Bicillin—has been in short supply in the United States, CNN’s Jacqueline Howard wrote in October. In January, the Food and Drug Administration made an equivalent treatment available to address the shortage.

In October, the Indian Health Service announced a new initiative that includes resources for supporting tribal communities in preventing syphilis and other sexually transmitted infections. The CDC also published draft guidelines on how men who have sex with men and transgender women could use the antibiotic doxycycline to prevent becoming infected with sexually transmitted infections.

“Some people face tremendous barriers to STI prevention and health services,” Bachmann says in the statement. “So, the most important work is often outside the clinic, whether it be reaching out to communities with testing, interviewing patients to offer services to their partners, or delivering treatment directly to someone.”

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