By More than 2.5 million cases of chlamydia, gonorrhea and syphilis were reported in the United States in 2022 as the country’s epidemic of sexually transmitted infections continues to grow.
Chlamydia accounted for about two-thirds of the STIs that were reported in 2022, according to an annual report published Tuesday by the US Centers for Disease Control and Prevention. But while chlamydia cases held steady and reported cases of gonorrhea decreased in 2022, syphilis cases continued to climb to the highest level in decades, with a 17% percent jump in one year.
“Within the STI epidemic, syphilis is one infection that stands alone,” Dr. Laura Bachmann, acting director of the CDC’s Division of STD Prevention, said in a statement. “It has emerged as a unique public health challenge.”
STIs do not often show symptoms, but Dr. Kimberly Stanford, an associate professor of emergency medicine at the University of Chicago, said that more severe cases have become a regular occurrence.
“When I was in training, I can’t recall ever seeing an obvious case of primary or secondary syphilis,” said Stanford, who leads an STI screening program but was not involved with the new CDC report. “We’re now seeing vascular complications; we’re seeing really severe surgical emergencies – things you read about in textbooks.”
Growing rates of syphilis among women also threaten the health of babies in the US, Bachmann said.
There were 3,755 babies born with congenital syphilis in 2022, a 10-fold increase over the past decade and a 31% spike year-over-year; these cases caused 282 stillbirths and infant deaths in 2022.
The vast majority of congenital syphilis cases in the US – nearly 90% – might have been prevented with better testing and treatment, a recent CDC report said.
The agency has emphasized the need for innovative solutions and prevention strategies to tackle the broader STI epidemic, especially in communities that are most affected.
Stanford said that priorities for prevention should include increasing public awareness of the issue, lowering the financial cost of screening, educating clinicians and making screening more accessible in nontraditional locations like prisons.
“The bottom line is, if we want to get ahead of this, we need to think about where people are and what their barriers are. We’ve got to start thinking creatively about how to address those barriers,” she said.
Syphilis cases increased for nearly every demographic group in the US in 2022, the new CDC report shows, but longstanding inequities persist.
The rate of reported syphilis cases was highest among American Indian and Alaska Native people in 2022, with about 67 cases for every 100,000 people. This rate is comparable to rates from the pre-penicillin era, when syphilis was difficult to cure, according to the US Department of Health and Human Services. And for every 155 births among American Indian and Alaska Native women in 2022, there was one congenital syphilis case, the CDC data shows.
The rate among Black people — about 44 cases for every 100,000 people — was more than four times the rate among White people, who had about 10 reported cases for every 100,000 people. The rate among Hispanic people — about 19 cases for every 100,000 people — was nearly twice as high, according to the new CDC report.
“We cannot continue to use decades-old prevention strategies to address today’s STI epidemic. People need testing and treatment to meet them where they are,” Bachmann said. This is often outside of traditional health care settings, emphasizing the need for broad collaboration.
Budget constraints and other challenges have strained a system that the CDC says is at a “tipping point,” especially after the public health emergency for Covid-19 diverted already limited resources. Reported cases probably underestimate the true burden, too, as challenges to access to testing could limit how often cases are diagnosed.
In June, CDC officials sent a letter to grantees announcing the loss of funding for STI prevention programs, spurred by congressional budget cuts. And drug shortages have directly affected the supply of Bicillin, an antibiotic used to treat syphilis.
“It’s like having the rug pulled out from under us,” Elizabeth Finley, communications director for the National Coalition of STD Directors, said in June.
“We have the rising rates of congenital syphilis, one of the most concerning issues in the STI field right now. And we look at the loss of drugs, these biomedical tools, to get the job done,” she said. “And then we look at losing the boots on the ground to do the work, and we really feel like our hands are tied as we see these rates rising.”
In November, the US Department of Health and Human Services stepped in and established a task force that can leverage federal resources to respond to the epidemic of syphilis and congenital syphilis cases. The agency has started hosting workshops to gather community input on strategies and made efforts to share information and resources among health care providers and partners. They’ve also shared intentions to leverage funding flexibilities to support grant programs that use funds to build STI counseling, testing and treatment services, among other plans
And the US Food and Drug Administration announced this month that it is working with a French drugmaker to temporarily allow imports of an alternate medication to treats syphilis amid an ongoing shortage of the front-line treatment. About 3.5 million units of Extencilline, which is not approved in the US, will be imported from French drugmaker Laboratoires Delbert.
“In the United States, syphilis was close to elimination in the 1990s, so we know it’s possible to reverse this epidemic,” Dr. Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said in a statement. “I have hope for innovative prevention tools – such as a pill after sex that prevents STIs, and better tests for syphilis – but they will only be successful if they reach the people who will benefit. And that is going to require coordinated and sustained efforts at the federal, state, and local levels.”
