Syphilis in the U.S was Once Nearly Eradicated. Here’s Why it’s Surging Again Transcript

According to the CDC, the number of syphilis cases in the United States is the highest it’s been since the 1950s. Ali Rogin looks at what’s behind this surge of this sexually transmitted infection or STI and what public health officials are doing about it.

Syphilis was close to being eradicated in the US in the 1990s. But in the decade since, funding for prevention and treatment has stagnated, and the number of cases have risen steadily. According to the latest report from the CDC, cases of syphilis shot up 80% from 2018 to 2022 alone. Dr. Philip Chan is the Chief Medical Officer for Open Door Health, a center for LGBTQ+ patients in Rhode Island, and an associate professor at Brown University. Dr. Chan, thank you so much for joining us. Why are syphilis cases on the rise, and should we be concerned about this?

Syphilis unfortunately has been increasing for a couple decades here in the US as largely gone unnoticed. It’s increasing now and circulating among the cisgender, heterosexual population, and we just aren’t testing enough, and we don’t have the infrastructure needed to address this increase, not only in syphilis, but also other STIs.

As you mentioned, cases are rising among cisgender people, particularly cisgender women and heterosexual people. Why are we seeing the increases in those populations in particular?

I think the syphilis has gotten a foothold in that population, and especially among populations that have been marginalized, a little bit more African-American, Black, Hispanic, Latinx communities, and we’re just seeing a spread because we aren’t testing enough. Congenital syphilis especially is a huge concern. It can cause really significant complications for the unborn baby up to and including death.

(01:43)
A lot of women from especially underserved communities aren’t getting prenatal care. It is recommended and required in many states that pregnant women do undergo syphilis testing. So, the fact that we’re missing these cases, the fact that we’re seeing congenital syphilis, I think shows us that a lot of folks aren’t getting the prenatal care that they need.

How did the COVID-19 pandemic disrupt STI treatment and detection of syphilis cases?

What we saw during the pandemic was that a lot of clinics closed. A lot of staff were reassigned to deal with COVID-19, and a lot of cases went undiagnosed. I think on the other hand, a lot of folks had less sex potentially, so we may not have been seeing a lot of transmission, but there was definitely some transmission that was going on that was unrecognized.

The rising cases in the last decade has coincided with a drop in funding for STI screening and prevention. Congress cut $400 million for disease investigators as part of the debt ceiling negotiation last year. How is this going to affect the existing resources for testing and detection?

I think the health departments in all states are really critical centers for addressing the STI epidemic. They’re responsible for communicating with partners, for disseminating funding, for contact tracing and partner notification services. So, this reduction in funding has really been harmful to the health departments. We definitely need more infrastructure. We need more funding. We need more resources to address this increase in STIs.

And since last year, there’s also been a shortage of penicillin, which is the most effective drug used to treat syphilis in adults, and the only drug that can treat pregnant women to prevent congenital syphilis. How are people dealing with that shortage, and will these shortages make the existing problem even worse?

So, the good news is that syphilis remains highly sensitive to penicillin, which is generally a common antibiotic. Unfortunately, you do need a little bit of a long acting formulation. At this time, we are having a shortage of benzathine penicillin, the formulation that we use to treat syphilis and specifically the pregnant women. What we’re doing is really prioritizing people who are pregnant for the benzathine penicillin. We’re using alternative antibiotics for other people. It’s not great, but it’s what we’re doing while there’s a shortage.

Yeah, we’re aware that there are efforts to use a drug called doxycycline as post-exposure prophylaxis. How effective is that?

This is one of the most exciting things in the field of STIs. A lot of us are really hopeful that it’s going to be a game changer as we talk about addressing STIs. So, doxycycline is a pretty common antibiotic, and there’s studies now that show that it’s really effective in preventing syphilis, chlamydia, and gonorrhea.

(04:30)
So, we expect some CDC recommendations in the near future, but it’s going to be recommended to prevent STIs. The data is strongest in gay, bisexual, other men, heterosexual men, and transgender women. We’re hoping it’s really going to be a game changer in preventing and addressing the STI epidemic.

You mentioned a few other STIs, gonorrhea, and chlamydia. Interestingly, gonorrhea is down slightly for the first time in a decade, and chlamydia cases have remained stable. If these infections are resulting from those same sexual practices and health issues that we’ve already discussed, why are those other two rates stabilizing while syphilis is on the rise?

Well, I think it’s good news. I think it also remains to be seen. This is a single data point from last year, the data that we have. But reassuringly, these STIs have remained stable, but I think it remains to be seen whether or not this trend continues.

(05:18)
I do think all these STIs are transmitted slightly differently. Slightly different attack rates in terms of being transmitted to other people. And I think for things like gonorrhea especially, we see slightly less attack rates and potential for transmission compared to chlamydia especially.

Dr. Philip Chan, Chief Medical Officer for Open Door Health, and Associate Professor at Brown University. Thank you so much for your time.

Thank you for having me.