Syphilis Cases in the United States Reach Highest Levels Since the 1950s, CDC Reports
Syphilis cases in the United States have reached alarming levels, with an increase of about 80 percent between 2018 and 2022, according to a report by the Centers for Disease Control and Prevention (CDC). The recorded cases of syphilis rose from approximately 115,000 in 2018 to over 207,000 in 2022, marking the highest numbers seen since the 1950s.
The surge in syphilis cases is a stark reversal from the turn of the century when public health experts believed the disease was on the verge of being eradicated domestically. Jonathan Mermin, director of the CDC’s National Center for HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, attributes the spike to various factors. These include decreased condom use and rising substance abuse, which has been linked to unsafe sexual practices.
However, experts agree that the primary cause of the increase in syphilis cases is a lack of funding dedicated to tackling the disease. The CDC’s STD prevention budget has remained relatively stagnant since 2003, leading to financial constraints due to inflation and population growth. As a result, there have been reductions in STI screening, treatment, prevention, and partner services by health departments.
“For many years, there have been reductions in STI screening, treatment, prevention, and partner services by health departments,” says Mermin. He attributes these cuts to economic constraints from the Great Recession and the loss of thousands of public health jobs. Insufficient funding has hindered efforts to control and prevent syphilis effectively.
Syphilis is a highly dangerous disease if left untreated. Approximately 25 percent of those infected experience serious complications that can damage vital organs such as the brain and heart. It can also lead to blindness, deafness, and paralysis. In addition, congenital syphilis, transmitted through the placenta, can result in stillbirth or death for about 40 percent of babies born to someone with untreated syphilis.
The rise of congenital syphilis prompted the National Coalition of STD Directors to call on the Biden administration to declare it a public health emergency, similar to the coronavirus epidemic and the opioid crisis. The symptoms of syphilis can vary depending on its stage, and it is often called “the great imitator” in medicine because it can resemble other diseases. Regular testing is crucial for control and prevention.
Condoms are generally effective in preventing transmission of syphilis through vaginal, anal, or oral sex with an infected partner. During and after World War II, the U.S. government launched campaigns to combat syphilis due to a rise in infections among American soldiers. Posters from that era depicted the deadly effects of syphilis and warned against its transmission.
In the 1990s, syphilis was close to elimination in the United States, with cases hitting an all-time low in 2000. However, the disease has made a resurgence in recent years, leading to a generation of physicians who are unfamiliar with recognizing and treating it.
The shortage of the antibiotic penicillin in the past year has further exacerbated syphilis treatment and driven up prices. Pfizer announced the shortage, citing increased demand due to rising syphilis infection rates. The shortage is expected to recover by the third quarter of 2024.
Syphilis disproportionately affects low-income communities where individuals are less likely to have health insurance or may delay treatment due to financial concerns. Advocacy for syphilis prevention and control has been lacking because those affected by the disease are often not in positions of power.
While more than a third of syphilis cases occur in men who have sex with men, experts are increasingly seeing the disease spread within heterosexual networks. Substance use, poverty, homelessness, and incarceration are factors associated with the heterosexual epidemic and pregnant women.
In a somewhat positive development, the CDC recorded an 8.7 percent decrease in known gonorrhea cases between 2021 and 2022, the first reported decline in at least a decade. However, experts caution that this may be due to a lack of testing, especially among women who often do not experience symptoms.
The surge in syphilis cases in the United States is a concerning public health issue that demands immediate attention and increased funding. Efforts to control and prevent the disease must be prioritized to avoid further complications and ensure the well-being of affected individuals and communities.
