Syphilis cases are on the rise in the US

The STI is spiking in all demographics

Illustration of syphilis bacteria.
The STI syphilis can be deadly if left untreated
(Image credit: CHRISTOPH BURGSTEDT / SCIENCE PHOTO LIBRARY / Getty Images)

The U.S. is seeing a resurgence in syphilis, a disease once almost completely eliminated in the country. The increase in drug use and the lack of sufficient medical care are contributing to the rising numbers. The drug most commonly used to treat the disease is also in short supply, which is requiring the U.S. to import a French firm's alternative. The disease can be deadly if left untreated and can lead to birth defects and miscarriages in pregnant women. 

Why is syphilis spiking?

The bacterial infection syphilis reached the highest rate of new infections since 1950 in 2022, according to the Centers for Disease Control and Prevention (CDC). The number of cases increased among every age group, and the uptick included cases of congenital syphilis. That version of syphilis had 11 times the number of recorded cases compared to a decade prior. South Dakota was the state with the highest rate of infections, and Native Americans and Alaska Natives were the ethnic groups with the highest rate of infections. "The syphilis epidemic touches nearly every community, but some racial and ethnic groups bear the brunt because of longstanding social inequities," Dr. Jonathan Mermin, director of the National Center for HIV, Viral Hepatitis, STD and TB Prevention at the CDC, said in The New York Times.

Syphilis can be dangerous if left untreated and can cause damage to the heart and brain, blindness, deafness and paralysis. If contracted during pregnancy, the disease could cause a miscarriage or stillbirth or lead to disabilities and developmental delays in surviving infants. While most common in gay and bisexual men, the condition is also rising in heterosexual men and women. The disease is "unknowingly being spread in the cisgender heterosexual population because we really aren't testing for it," Dr. Philip Chan, an associate professor at Brown University and chief medical officer of Open Door Health, said to The Associated Press.

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Experts believe that the increase in drug addiction across the country is playing a substantive role in the increase in cases. "Substance use, which is tied to risky sexual behavior, has risen. With better prevention and treatment for HIV, condom use has fallen out of vogue," the Times said. In addition, "sexual health services remain inadequate relative to the need pretty much everywhere," Dr. Jay Varma, chief medical officer at Siga Technologies and a former deputy commissioner of health for New York City, said to the source. "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."

What's being done?

Last year, the Department of Health and Human Services (HHS) organized a national task force for syphilis to "leverage federal resources to reduce rates, promote health equity, engage impacted communities and direct resources to support those most impacted," according to a press release by the HHS. "Addressing the resurgence of syphilis and congenital syphilis requires a concerted effort," said ADM Rachel L. Levine, Assistant Secretary for Health and chair of the National Syphilis and Congenital Syphilis Syndemic Federal Task Force. "We can collectively work towards reducing the incidence of syphilis and its devastating consequences, and we will turn the tide on the syphilis epidemic."

The mounting number of syphilis cases has spawned another problem: a medicine shortage. The best medication to treat the disease is penicillin G benzathine, which is sold as Bicillin L-A in the U.S. by the pharmaceutical company Pfizer. There has been a shortage of the drug since April 2023. To combat this, the Food and Drug Administration (FDA) approved a temporary import of an alternative form of penicillin G benzathine, commercially called ​​Extencilline, from the France-based Laboratoires Delbert. Extencilline had not previously been approved for use in the U.S. The FDA also suggested treating the condition with a different antibiotic called doxycycline, but "that medicine is significantly less convenient," because "while Bicillin L-A can cure syphilis with as little as one shot, doxycycline requires weeks of taking a pill twice a day," said Bloomberg. The spread of syphilis will likely only get worse without more government intervention. "Wishing hard won't prevent sexually transmitted infections," Mermin said to the Times. "We need sustained public health efforts."

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