Report details

According to the report, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States in 2022.

Rates of gonorrhea declined for the first time in a decade while chlamydia rates stayed mostly level. However, experts noted it's unclear whether 2022 marked an actual decline or just a lack of reporting and testing.

The report also found there were 207,255 syphilis cases in the United States in 2022, representing a 17% increase over the past year and an 80% increase over the past five years.

According to the report, there were more than 3,700 infants born with syphilis in 2022, the highest mark in at least 30 years and a tenfold increase over the past decade. Meanwhile, cases of primary and secondary syphilis increased 10% in 2022 and have increased 68% since 2018.

Syphilis disproportionately affected racial and ethnic minorities, the report found. Black Americans made up around 30% of all primary and secondary syphilis cases, while Native American/Alaskan Native people saw the highest rates at 67 cases per 100,000 people.

Almost 60% of all syphilis cases occurred in five states: Arizona, California, Florida, Louisiana, and Texas. New Mexico saw the highest congenital syphilis rates at 355.3 cases per 100,000 live births, followed by South Dakota (351.8), Arizona (281.1), Texas (246.8), and Oklahoma (227.2).

Discussion

According to Laura Bachman, acting director of CDC's STD division, the STI field "has reached a tipping point."

"We have long known that these infections are common, but we have not faced such severe effects of syphilis in decades," she said. "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," she added.

In the 1990s, syphilis was nearly eradicated, but it's made a comeback in part due to years of underfunding public health, increased rates of substance use, and the mental health crisis, The Hill reports. In addition, better treatment and prevention measures for diseases such as HIV mean that condom use has "fallen out of vogue," the New York Times reports.

Public health officials say they're concerned they don't have the resources to combat the recent surge, as many are still recovering from the COVID-19 pandemic and mpox outbreak.

"There's no question that during the pandemic, public health was busy doing a lot of other things and we diverted a lot of people and resources and just attention … and that probably caused us to lose some ground on the progress that we've been making," said Scott Harris, state health officer of Alabama.

"I think [syphilis is] unknowingly being spread in the cisgender heterosexual population because we really aren't testing for it," said Philip Chan, CMO of Open Door Health and a teacher at Brown University. "We really aren't looking for it."

And when cases get missed, they start to multiply, according to Jay Varma, CMO at Siga Technologies and former deputy commissioner of health for New York City.

"When you miss one case, you then end up with two more cases, and if you miss two cases, you then end up with four," he said. "That's how epidemics grow."

In addition, Congress is set to take back $400 million in public health workforce funds as part of a debt ceiling agreement between congressional leaders and President Joe Biden. If those cuts take effect, the National Coalition of STD Directors (NCSD) said states would need to lay off around 800 disease intervention specialists.

"What HHS says we need to do, what CDC says we need to do … rapid testing, reaching out to people in alternative settings and in places like prisons, those are all absolutely correct," said NCSD spokesperson Elizabeth Finley. "But communities can't follow through on that advice without funding and people to do it." (Weixel, The Hill, 1/30; Stobbe, Associated Press, 1/30; Millman, Axios, 1/30; Mandavilli, New York Times, 1/30)

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