The U.S. has seen an 80 percent increase in reported cases of syphilis over the past five years, leading experts to warn of an “out-of-control” sexually transmitted infection (STI) crisis.
In January, the Centers for Disease Control and Prevention (CDC) released its annual Sexually Transmitted Infections Surveillance report for 2022. The report opened with a grim statistic: “Yet again, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in the United States.”
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According to the report, cases of chlamydia remained level with those reported in 2021, while cases of gonorrhea saw an 8.7% decline.
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“Given this is the first drop in reported gonorrhea cases in at least a decade, we are examining this finding closely and will be looking to 2023 data to better understand if this signals a true decline in infections, or if this is related to changes in gonorrhea diagnoses and reporting in 2022,” the report states.
But the worsening rates of syphilis in the report led CDC Director for STD Prevention Laura Bachman to warn that “swift action is urgently needed to slow the curve.”
As Bachman noted, “Cases of primary and secondary (P&S) syphilis—the most infectious stages of the disease—increased 10 percent in 2022 alone and 68 percent since 2018.”
While primary and secondary syphilis are curable with antibiotics, the greatest risk is posed to babies who contract congenital syphilis during pregnancy or birth. Reported cases of congenital syphilis have increased by 183.4% over the last five years and by nearly 31 percent from 2021 to 2022. Over the past decade, rates have increased by 937 percent, a number Bachman called “alarming.”
“Texas, California, Arizona, Florida, and Louisiana represented 57 percent of all reported congenital syphilis cases,” Bachman wrote. “Tragically, these infections resulted in 282 stillbirths and infant deaths in 2022.”
According to the report, American Indian or Alaska Native people experienced the highest rate of congenital syphilis, while Black or African American people experienced nearly 30 percent of congenital syphilis cases in 2022.
“As disparities persist among some groups, it is evident that our nation must keep striving to address longstanding social inequalities that often lead to health inequalities and, ultimately, health disparities,” Bachman wrote.
“The STI field has reached a tipping point,” she continued. “We have long known that these infections are common, but we have not faced such severe effects of syphilis in decades. Recent public health emergencies diverted program resources and threatened the health of those already disproportionately affected by STIs. We must move now to pick up the pieces.”
The National Coalition of STD Directors responded to the report in January, calling the U.S STI epidemic “out-of-control.”
“The CDC’s latest STI data shows that our nation is facing a rapidly deteriorating public health crisis with real lives at stake,” the NCSDDC warned in a statement. “STIs – especially syphilis – will continue to spiral out of control until the administration and Congress provide communities with the funding they need to provide the most basic screening, treatment, and prevention services.”
NCSDDC also noted that the CDC report did “not reflect the impact of the shortage of congenital syphilis treatment drug Bicillin L-A, which started last spring, or last summer’s STI workforce cuts in the debt ceiling deal.”
“The 2022 surveillance data shows millions of people were impacted by entirely preventable infections,” NCSDDC’s statement continued. “Increasingly, though, women and babies have been forced to bear the most devastating consequences of the nation’s STI epidemic as syphilis and congenital syphilis continue to rage with treatment shortages, workforce cuts, and attacks on women’s healthcare only adding to the fire.”
NCSDDC praised the newly announced federal syphilis task force and the limited import of the drug Extencilline as “steps in the right direction” but called for “a response that fully meets the moment: one that pairs the new attention from HHS with the resources communities need to restore last year’s public health workforce cuts and implement the basic screening and treatment services HHS recommends.”
“As STI services and related resources continue to rebound from the U.S. COVID-19 pandemic and MPOX outbreak, we must act now to mobilize and execute a whole-of-nation approach if we hope to turn the tide,” the CDC’s Bachman wrote.
Last June, the Biden administration released a multi-agency plan to address rising STI rates. “The data we are seeing across the country calls for immediate and sustained action.” Assistant Secretary for Health Rachel Levine said at the time.
However, the plan has faced a number of hurdles both in Congress and the courts. The White House’s fiscal Year 2025 budget request, released in March, did not include increased federal funding for the CDC’s STI prevention efforts.
“We applaud the newly established federal syphilis taskforce chaired by Admiral Levine for adopting a whole-of-government approach to fighting syphilis. But without more funding, the task force will be severely restricted in what it can accomplish,” the CDC said in a statement at the time.
