Syphilis Rates Surging in the United States After Initial Progress

In an alarming change of direction for the United States, there has been a significant rise in syphilis cases, a disease once almost eradicated in the country.

Having decreased to less than 32,000 cases in 2000, syphilis rates have dramatically increased to above 207,000 in 2022, according to a January report from U.S. Centers for Disease Control and Prevention. This equates to approximately 62 cases per 100,000 individuals.

The situation is particularly devastating for pregnant individuals and their babies. The CDC reported on February 13 that the rate of maternal syphilis during pregnancy has risen from 87 per 100,000 births in 2016 to 280 per 100,000 births in 2022. Without medical intervention, the infection can be transmitted from pregnant individuals to the fetus, potentially causing congenital syphilis, which can lead to miscarriage, stillbirth, premature birth, serious health issues after birth or even death. In 2022, over 3,700 babies were born with syphilis, which is about ten times the number recorded in 2012.

Testing is a pivotal component of managing the disease, as syphilis often mimics other medical conditions or can be symptom-free, so says Allison Agwu, an infectious disease clinician and researcher at Johns Hopkins School of Medicine. People can usually get tested for syphilis through a blood test, which can be done by a primary care provider, at a public health clinic or an urgent care facility. Agwu encourages regular testing for syphilis and attempts to destigmatize the conversation around the disease, stating that anyone who has ever been sexually active should be tested.

Agwu spoke to Science News about the drastic surge in syphilis cases and what measures need to be taken to control the disease.

When asked about the reasons for the rise in syphilis cases in the US, Agwu explained that it is a multifaceted problem. Many times, syphilis is asymptomatic, so people can have it for years without realizing it, especially if they missed its symptomatic phase. Reduced access and funding for public health infrastructure has increased the impact in communities that rely heavily on these services but now have limited access. Other contributing factors include stigma and medicine shortages.

Agwu believes that tests for syphilis should be more readily available, especially during pregnancy. If a pregnant woman is diagnosed with syphilis, prompt treatment can prevent transmission to the baby. Agwu opines that healthcare providers need to provide adequate counseling about maintaining a negative status during pregnancy, a discussion often missing from standard prenatal care.

The pattern of maternal syphilis infection, which is measured as the number of births to women with syphilis per 100,000 live births, has increased among all groups between 2016 and 2022. The most noticeable increase (783 percent) has been observed among women of American Indian and Alaska Native descent giving birth.

To reduce the current syphilis rates, Agwu suggests education as a critical tool. This should include straight-forward information about the ways the disease can be contracted, how and where to test for it, without using fear as a motivating factor.

We need to normalize sexuality and sexual exploration and not vilify it. We need to destigmatize the diagnosis so people are more likely to then tell their partners, so their partners can also get tested and treated. Instead of having someone prove that they need to have additional testing, how about we just test people — instead of creating a stigma around, well do you need to get tested again. Acknowledging that people are sexual beings, even when they’re pregnant.

COVID-19 really highlighted the problems we were having with our public health infrastructure. We need to think about how we can effectively provide sexual health care and give testing, prevention, treatment all in a way that is packaged in a positive light. Take it out of the dark.

Syphilis — caused by the bacteria Treponema pallidum — is described in terms of stages.

In the first stage, the only sign is one or several sores at the site a person was infected, such as on the penis, around the vagina, in the anus or mouth. The sores are usually painless and remain for three to six weeks. During the second stage, people can have a rash, headaches, fever, muscle aches or fatigue.

Once those symptoms pass, a person can be asymptomatic for years. But some people progress to a fourth, potentially fatal stage, which damages many organs, including the brain, nerves and heart.

The guideline for asymptomatic adolescents and adults is to test those who have been sexually active and are at increased risk, which includes people who have an HIV infection or other sexually transmitted infections and men who have sex with men. The recommendation for pregnant people is to test for syphilis as early as possible, ideally during their first prenatal visit.

Syphilis is treated with a shot of a special formulation of penicillin. There has been a shortage of the drug, which is the only effective treatment during pregnancy. Nonpregnant people can also take the oral antibiotic doxycycline for treatment.