Cross-posted from: HHS Newsroom

U.S. Syphilis Cases Reach Highest Levels Since the 1950s, Creating a Critical Public Health Need

In response to the surging number of syphilis and congenital syphilis cases nationwide, the U.S. Department of Health and Human Services (HHS) is taking action to slow the spread with a focus on those most significantly impacted. Through the establishment of the National Syphilis and Congenital Syphilis Syndemic (NSCSS) Federal Task Force, the Department is utilizing its agencies, its expertise, and its stakeholder network to respond to the U.S. syphilis and congenital syphilis epidemic. The actions of the Task Force leverage federal resources to reduce rates, promote health equity, engage impacted communities, and direct resources to support those most impacted.

“The syphilis crisis in our country is unacceptable. The Biden-Harris Administration is committed to addressing this urgent issue and using all available means to eliminate disparities in our health care system,” said HHS Secretary Xavier Becerra. “These actions we are taking will help ensure we are improving outcomes for birthing parents and newborns. We must prevent more deaths caused by congenital syphilis, an entirely preventable disease.”

According to a Centers for Disease Control and Prevention (CDC) CDC report published today, 207,255 total syphilis cases were reported in the United States in 2022, representing an 80% increase since 2018 and continuing a decades-long upward trend. Cases in nearly every demographic group and region increased, as did disparities in the burden of disease among certain racial and ethnic populations.

According to the report, more than 3,700 cases of congenital syphilis were documented among newborns in 2022—more than 10 times the number diagnosed in 2012.

If untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness, and paralysis. When transmitted during pregnancy, it can cause miscarriage, lifelong medical issues, and infant death. 

“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.”

Actions already taken by in tackling the syphilis epidemic include:

• In July 2023, the Health Resources and Services Administration (PDF, 196KB)(HRSA) and Indian Health Service (PDF, 340KB) (IHS) issued letters to grantees and providers that included informational resources to address the epidemic in American Indian and Alaska Native communities.
• In October 2023, CDC published the agency’s first draft guidelines outlining how some gay, bisexual, and other men who have sex with men and transgender women could use the common antibiotic doxycycline to prevent acquisition of syphilis, as well as gonorrhea and chlamydia. 
• In October 2023, IHS announced a new national clinical strategic initiative (PDF, 152KB)that includes resources to support tribal communities in preventing syphilis and other sexually transmitted infections. The agency also released Sexually Transmitted Infection (STI) Treatment Guidance for IHS, Tribal, and Urban Indian organizations concerning best practices for syphilis testing and treatment in Native communities. 
• In December 2023, HHS generated heatmaps for priority jurisdictions to overlay primary and secondary syphilis and congenital syphilis cases with HHS resources, including Title X family planning clinics, Ryan White clinics, IHS clinics and Federally Qualified Health Centers.

HHS has taken a number of actions in the new year and continues to proactively stop the spread of syphilis:

• In January 2024, the U.S. Food and Drug Administration (FDA) announced the availability of Extencilline® in the United States to address the ongoing shortages of Bicillin L-A®. FDA exercised enforcement discretion for a temporary importation and use of Extencilline® to mitigate the effects of the Bicillin L-A® drug shortage. Extencilline® is currently authorized and marketed in other countries. For differences between Extencilline® and Bicillin L-A®, please refer to the DHCP letter posted on the drug shortage website.
• HHS is leading a workshop series to gather community input on how best to improve syphilis and congenital syphilis outcomes, including how to better support community efforts to improve health equity and support related syndemic, sexual, and reproductive health services. In January 2024, the series began with two workshops—one with American Indian and Alaska Native tribes and the other with providers who represent people disproportionately affected by syphilis and congenital syphilis. In February, additional workshops will be held on syphilis prevention, treatment, and other related issues.
• In February 2024, HHS and CDC will co-host a provider roundtable on Congenital Syphilis Prevention. Health care providers have a critical role in reversing this alarming trend and protecting the health of our nation’s patients and their babies. The roundtable will focus on HHS’s available resources that providers can use to reduce the incidence of congenital syphilis and will solicit feedback on what additional resources are required to help reduce the rates of congenital syphilis.
• The Department will continue to meet with the priority areas and hold engagement sessions focused on directing resources to support those most impacted.
• The Department will continue to work with professional medical societies and national public health organizations to provide tools and information to help inform clinical care around congenital syphilis.
• The Department plans to leverage funding flexibilities for grant programs to enhance use of grant funds, including staff time, for STI counseling, testing, and treatment services.
• The Department will develop considerations for point-of-care testing in priority jurisdictions.
• The Department will host a workshop on the expansion of syphilis treatment with NIH researchers.

“In the United States, syphilis was close to elimination in the 1990s, so we know it’s possible to reverse this epidemic,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “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.”

• While the syphilis epidemic touches nearly every community, some racial and ethnic groups bear the brunt due to longstanding social inequities that often lead to health disparities.
• Despite comprising 13% of the U.S. population and 14% of live births, Black or African American people represented nearly 32% of all primary and secondary syphilis cases and experienced about 30% of congenital syphilis cases in 2022.
• Primary and secondary and congenital syphilis rates were highest among American Indian or Alaska Native people—comparable to rates from the pre-penicillin era when syphilis was difficult to cure.
  • For every 155 American Indian and Alaska Native births in 2022, there was one congenital syphilis case.

The vast majority of primary and secondary syphilis cases were diagnosed outside of STD clinics in 2022, according to CDC’s new report. This finding emphasizes the vitally important role of health workers in a variety of settings—including primary care, emergency departments, community health, correctional, and drug treatment programs. 

Additional innovation, research, and investment are critical to prevent and control STIs. Equitably stopping the syphilis epidemic and addressing the nation’s broader STI challenges requires a coordinated and sustained effort shared by federal leadership, state and local health departments, healthcare systems, providers, and private industry.