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HHS launches syphilis strategy amid rising cases

New data shows rates of syphilis increasing nearly 80 percent in five years

An electron photomicrograph of two spiral-shaped Treponema pallidum bacteria. T. pallidum Is the causative agent of syphilis.
An electron photomicrograph of two spiral-shaped Treponema pallidum bacteria. T. pallidum Is the causative agent of syphilis. (BSIP/UIG via Getty Images)

Public health officials are sounding the alarm on new Centers for Disease Control and Prevention data that shows rapidly increasing rates of sexually transmitted infections as the Biden administration announced new actions to slow the spread of syphilis.

The CDC data, released Tuesday as part of its 2022 STI Surveillance Report, shows more than 2.5 million documented cases of chlamydia, gonorrhea and syphilis in the United States. Chlamydia and gonorrhea are the two most frequently occurring forms of STIs, accounting for more than 90 percent of the 2022 cases, the data showed. 

Cases of chlamydia remained level, while gonorrhea cases declined by almost 9 percent in 2022. The gains were largely from the syphilis and congenital syphilis epidemics, with all syphilis rising nearly 80 percent in five years.

Some regions faced worse outcomes.

Chlamydia rates per 100,000 residents were highest in Louisiana, Mississippi and Alaska, while gonorrhea rates were highest in Mississippi, South Dakota and Louisiana. 

South Dakota had the highest rate of primary and secondary syphilis cases and second-highest rate of congenital syphilis cases, while New Mexico had the highest congenital syphilis rates and the second-highest primary and secondary syphilis case rates.

“There are no shortcuts, and we have to meet people where they are. Some people face tremendous barriers to STI prevention and health services,” said Laura Bachmann, acting director of the CDC’s Division of STD Prevention.

CDC said it is working to issue final guidance on using doxycycline, a commonly used antibiotic, for post-exposure prophylaxis to prevent bacterial STIs, which would be the first large-scale bacterial STI prevention innovation in decades. The Biden administration announced the first national multiagency plan to reduce climbing rates of STIs last year.

While chlamydia and gonorrhea account for the bulk of the cases in 2022 — 1.65 million and 648,100, respectively —syphilis, though rising, is comparatively more rare, with 203,500 cases in 2022. That doesn’t include 3,755 congenital syphilis cases.

The Department of Health and Human Services announced Tuesday the launch of a new task force that will focus on the rise of syphilis cases, including in newborns. 

The task force will “leverage” federal resources to reduce rates and direct resources to communities most impacted by rising rates. 

Particularly concerning to public health experts is the rise in congenital syphilis cases.  More than 3,700 cases were documented among newborns in 2022 — more than 10 times the number diagnosed in 2012. 

The task force’s goal is to avert 5 percent of congenital syphilis cases by September. Infected mothers can pass the disease to their unborn babies, causing serious health issues and death.

Congenital syphilis is highly preventable, and the CDC recommends getting tested for syphilis three times during pregnancy. Many people who give birth to infants with syphilis have received no prenatal care or testing.

During the next 90 days, the task force will work to expand syphilis testing, particularly among pregnant people and people in communities with limited health care access, and work with health departments to identify counties with high rates.

It will promote alternative testing locations for pregnant people beyond traditional prenatal care settings, such as substance use treatment facilities, harm reduction programs and emergency departments. It will also educate health care providers who treat pregnant people about the importance of testing.  

“These actions we are taking will help ensure we are improving outcomes for birthing parents and newborns,” HHS Secretary Xavier Becerra said in a statement. “We must prevent more deaths caused by congenital syphilis, an entirely preventable disease.”

But experts worry the data downplays the impact of the rising numbers.

The congenital syphilis treatment drug Bicillin L-A has been in shortage since last spring, and the National Coalition of STD Directors has said the impact of the debt ceiling deal has also affected the STI workforce.

“The reality is that the 2023 data will be worse. The Biden administration deserves praise for putting the spotlight on the most severe consequence of the nation’s STI epidemic — congenital syphilis — but we know all too well that federal leadership will prove hollow if communities don’t have the funding they need to get the job done,” the National Coalition of STD Directors said in a statement Tuesday.

The group said the new federal syphilis task force and recent action by the Food and Drug Administration to import some Extencilline, an alternative to Bicillin L-A,  are steps in the right direction but called for a federal “response that fully meets the moment: one that pairs the new attention from HHS with the resources communities need to restore last year’s public health workforce cuts and implement the basic screening and treatment services HHS recommends.”

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