April is STD Awareness Month, and this year’s theme is Syphilis Strikes Back. This theme was chosen by the Centers for Disease Control and Prevention’s (CDC’s) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention as a reminder that, despite the elimination of syphilis being within reach just a decade ago, we are seeing a dramatic resurgence in new syphilis infections in the U.S. today. To highlight the most impacted populations and the roles of local health departments (LHDs) in combatting this growing epidemic of syphilis, NACCHO’s Essential Elements of Local Public Health blog will feature a series of STD Awareness Month posts throughout the month of April. Today’s post provides an overview of the state of the syphilis epidemic, and will set the stage for the posts to follow throughout the month.
Syphilis is a prevalent and expanding public health issue in the U.S. In 2015, there were nearly 75,000 new syphilis infections reported – a 17.7% increase over 2014. Syphilis is a bacterial infection that is primarily spread through sexual contact, but the disease can also be transmitted from mother to child during pregnancy. Any sexually active person can acquire syphilis, but men who have sex with men (MSM) and women of childbearing age are especially impacted. While treatable, syphilis infections that remain undiagnosed or untreated can cause neurological damage including permanent blindness and dementia, fetal death or developmental delays, and skin sores that can increase the risk of transmitting and acquiring HIV infection.
According to the most recent data provided by CDC, in 2015 the rate of primary and secondary syphilis (the most transmissible stages of infection) in the U.S. increased to 7.5 cases per 100,000 – a 19.0% increase from 2014, 66.7% increase from 2011, and the highest rate in over two decades. This increase markedly affects MSM: for male cases in which the sex of the sex partner was known, 81.7% were among MSM, and where HIV-status was also reported, 51.2% of syphilis cases among MSM were also HIV-positive. This further highlights the burden and impact of syphilis on the MSM community.
Increasing rates of syphilis among women of childbearing age and among newborns (congenital syphilis) are also growing concerns. In 2015, nearly 500 cases of congenital syphilis were reported, and these cases were disproportionately found among infants born to black and Hispanic mothers. In fact, compared to infants born to white mothers, rates of congenital syphilis were eight times higher among infants born to black mothers, and 3.5 times higher among infants born to Hispanic mothers. Disturbingly, rates of syphilis found among babies who were miscarried or stillborn have increased in each of the last two years.
While rates of syphilis among MSM and newborns are again increasing, rates of syphilis are also rising across many populations in the U.S. In fact, in one year, between 2014 and 2015, syphilis rates increased for both men and women in every age group (among 15-64 year olds), in every region of the country, and among every race/ethnicity except for American Indians/Alaska Natives
Over the next three weeks, posts in this blog series will focus on understanding why syphilis rates are again on the rise and why certain populations are disproportionately impacted by syphilis. The series will also highlight how NACCHO and LHDs are working to address growing rates of syphilis at the local level, including through a project supported by CDC’s Division of STD Prevention to evaluate the implementation of rapid syphilis testing (RST) by LHD STD programs in nonclinical community settings. The project will contribute valuable data and perspectives to inform the use of RST by LHD STD programs among hard-to-reach populations impacted by syphilis.
Look out for the next post in the series on April 13th and, in the meantime, check out CDC’s resources on syphilis, participate in CDC’s Syphilis Strikes Back Thunderclap, and use sample STD Awareness Month tweets and Facebook posts on your social media accounts.