Syphilis, almost eliminated in the United States, continues to reappear, reaching the highest rate of new infections recorded since 1950the Centers for Disease Control and Prevention said Tuesday.
More than 207,000 cases were diagnosed in 2022, the latest year for which data is available. That’s an increase of 80% since 2018 and 17% from the previous year, according to a new report from the CDC.
Rates have climbed in all age groups, including newborns. In November, the CDC said more than 3,700 cases of congenital syphilis had been reported in 2022, about 11 times the number recorded a decade ago. The disease caused 231 stillbirths and 51 infant deaths in 2022.
Experts have pointed to numerous reasons for the continued rise in syphilis and other STIs.
Substance use, linked to risky sexual behavior, has increased. With better HIV prevention and treatment, condom use has become obsolete – decreasing by about 8 percentage points between 2011 and 2021 among high school students for example.
And, importantly, there are far fewer sexual health clinics, as well as disease intervention specialists and nurses working in them.
Syphilis is on the rise even in countries with national health systems because “sexual health services remain inadequate relative to needs almost everywhere,” said Dr. Jay Varma, chief medical officer of Siga Technologies and former deputy health commissioner of New York. City.
“But it’s particularly a problem here in the United States,” Dr. Varma said.
“When you miss one case, you end up with two more cases, and if you miss two cases, you end up with four,” he added. “This is how epidemics develop.”
With more than 84 cases per 100,000 people, South Dakota had the highest rate of syphilis infections, more than double that of New Mexico, the next state with the highest incidence. (Arkansas, Oklahoma and Mississippi round out the top five.)
Black Americans accounted for about 30 percent of primary and secondary syphilis cases. But at 67 cases per 100,000 people, American Indians/Alaska Natives had the highest rates.
“The syphilis epidemic affects nearly every community, but some racial and ethnic groups bear the brunt of it due to long-standing social inequities,” said Dr. Jonathan Mermin, director of the National HIV Prevention Center, viral hepatitis, STDs and tuberculosis at the CDC.
Untreated, syphilis can damage the heart and brain and cause blindness, deafness and paralysis. Infection during pregnancy can lead to miscarriage and stillbirth, and infants who survive may become blind or deaf, or have severe developmental delays.
Chlamydia is a much more common sexually transmitted infection, with almost 1.7 million cases. Reported diagnoses fell sharply in 2020 and began to recover in 2021; the rate in 2022 remained stable.
Gonorrhea had been constantly increasing after a historic low in 2009, but appeared to decline in 2022, dropping to around 648,000 cases from more than 700,000 the previous year. Rates declined by race, gender and age, but the decline was most pronounced among women aged 20 to 24.
But without confirmation that these trends are real, “we shouldn’t celebrate,” said Dr. Ina Park, an STI expert at the University of California, San Francisco.
“Both of these diseases are often asymptomatic,” Dr. Park said. “If we’re seeing a decline among young women, it may be because they’re just not being screened.”
The Biden administration has taken several steps to combat STIs. Last summer, the Department of Health and Human Services established a national syphilis task force, which focuses on the 14 jurisdictions with the highest rates, according to Adm. Rachel Levine. , deputy secretary of the department.
The CDC has proposed prescribing doxycycline, a widely used antibiotic, to gay and bisexual men and transgender women who have had unprotected sex. The Food and Drug Administration has temporarily authorized the importing an alternative to the treatment of syphilis Bicillin LA, which is rare in the United States.
The FDA has also authorized the first home sample collection kit for chlamydia and gonorrhea. And the CDC is helping develop a simple test for syphilis that can be used in clinics over the next two years, Dr. Mermin said.
About 86 percent of syphilis cases were diagnosed outside sexual health clinics in 2022, Dr. Mermin said. This suggests that controlling the outbreak will require primary care physicians, emergency departments, community health centers, and correctional and drug treatment programs to screen for infection.
“Wishing a lot won’t prevent sexually transmitted infections,” Dr. Mermin said. “We need sustained public health efforts. »