US sees record syphilis cases as funding cuts threaten to worsen epidemic

Syphilis rates have continued to surge, reaching levels the nation hasn’t seen since 1950, according to new federal data released Tuesday. 

According to the report from the Centers for Disease Control and Prevention (CDC), syphilis cases increased 17 percent in the past year and 80 percent in the past five years. With Congress set to cut the funding for workers who fight sexually transmitted infections, experts warn the record-setting epidemic isn’t likely to abate. 

“The STI [sexually transmitted infection] 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,” Laura Bachmann, acting director of the CDC’s STD division, said in a statement.  

“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,” Bachmann said. 

More than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States in 2022, though officials are most alarmed about the syphilis and congenital syphilis epidemics.  

Reported gonorrhea cases declined for the first time in at least a decade while reported chlamydia cases were level. But the report noted it’s not clear if 2022 marked a true decline or merely a change in reporting and testing.  

Syphilis was nearly eradicated in the 1990s in the U.S., but it’s come roaring back largely due to years of underfunding public health, along with increasing rates of substance use and the mental health crisis.  

The CDC reported 207,255 syphilis cases across nearly every demographic group and region in 2022, including newborns. In November, health officials reported a concerning rise in congenital syphilis — when an untreated infection in a parent is passed to an infant during birth. 

According to the CDC, there were more than 3,700 infants born with syphilis in 2022, the highest level in at least 30 years and a tenfold increase over the past decade. It’s a disease that impacts red and blue states alike — Texas, California, Arizona, Florida, and Louisiana represented 57 percent of all reported congenital syphilis cases in 2022. 

Cases of primary and secondary syphilis — the most infectious stages of the disease — increased 10 percent in 2022 and 68 percent since 2018.  

Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death and lifelong medical issues for both mother and baby. The disease is easily preventable if people can be reached with screening and treatment.   

However, public health officials said they are worried they don’t have the resources to combat the surge. Health departments are still recovering from the COVID-19 pandemic and mpox outbreak, and Congress is poised to claw back $400 million in public health workforce funds as part of the debt ceiling agreement between President Biden and congressional leaders.  

“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, the State Health Officer of Alabama.  

The National Coalition of STD Directors found states would need to lay off about 800 disease intervention specialists if Congress doesn’t stop the cuts from taking effect.  

“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. But communities can’t follow through on that advice without funding and people to do it,” said NCSD spokeswoman Elizabeth Finley. 

Harris said Alabama will lose about 24 front-line staff who work directly with patients seeking treatment for STIs, which poses a problem for a rural state with a large Black population. 

Racial and ethnic minorities are disproportionately affected by syphilis. Black Americans comprised about 30 percent of primary and secondary syphilis cases, but Native American/Alaska Native people had the highest rates with 67 cases per 100,000 people. 

“Black Americans and Black Alabamians are disproportionately affected by STIs. People who are low income are disproportionately affected by STIs. Certainly, there are many low income Black Alabamians, who would then seem to be at risk … and so, we do have a lot of concern about what the what the future is going to hold there,” Harris said.