Syphilis Rates at Highest Level in Decades

The CDC says syphilis cases have risen 80% in the past five years, while other sexually transmitted infection rates have remained the same or decreased.

Just a few decades ago, syphilis wasn't a significant concern in the United States due to the widespread availability of antibiotics. However, a new Centers for Disease Control and Prevention (CDC) surveillance report shows that the rates of this potentially dangerous sexually transmitted infection (STI) are skyrocketing.

Specifically, the data shows the U.S. is experiencing the highest number of cases since 1950, and the reasons for this uptick are unclear.

According to the report, in 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the U.S., with the total number of syphilis cases topping 207,000.

Moreover, syphilis cases have increased by 80% in the past five years, and rates of highly infectious primary and secondary syphilis rose 10% in 2022 and an alarming 68% since 2018.

The report shows that cases of congenital syphilis — when an infant acquires the infection during pregnancy — increased by 937% in the past 10 years.

Congenital syphilis can be particularly devastating. Among babies born to mothers with untreated syphilis, around 40% are stillborn or die from the infection. Congenital syphilis can cause infants to experience an enlarged liver and spleen, nerve problems resulting in blindness, and bone damage.

The CDC says that in 2022, Texas, California, Arizona, Florida, and Louisiana represented 57% of all reported congenital syphilis cases, which resulted in 282 stillbirths and infant deaths.

In 2022, American Indian or Alaska Native individuals experienced the highest rate of congenital syphilis, with one case in every 155 births. States that reported the highest rates of congenital syphilis per 100,000 people include New Mexico, South Dakota, Arizona, and Texas.

The data also showed that states with the highest number of primary and secondary syphilis cases per 100,000 people in 2022 were South Dakota, New Mexico, Arkansas, Oklahoma, and Mississippi.

Despite the uptick in syphilis, the CDC data shows that other STIs are either holding steady or decreasing. For example, in 2022, chlamydia cases stayed level, and gonorrhea cases fell by nearly 9%.

However, the CDC says it will closely examine 2023 gonorrhea case data to clarify if the 9% drop in cases signals an actual decline in infections or if the decline is related to changes in gonorrhea diagnoses and reporting in 2022.

CDC calls for more syphilis testing

In an announcement accompanying the report, Laura Bachmann, M.D., MPH, Acting Director of the CDC's Division of STD Prevention, called syphilis a "unique public health challenge."

Bachmann urged healthcare providers to learn more about who should be tested for syphilis, discuss sexual health with their patients, and work with state and local health departments to boost access to treatments.

Moreover, the CDC is working on final guidance for using doxycycline in people exposed to bacterial STIs.

The U.S. Department of Health and Human Services is stepping up to the challenge by creating the first-of-its-kind National Syphilis and Congenital Syphilis Syndemic Federal (NSCSS) Task Force. The new Task Force seeks to help move syphilis prevention forward, reduce infection rates, and promote health equity for the prevention and treatment of STIs.