The Covid-19 pandemic has understandably dominated the news cycle for almost 2 years now. As we hopefully get past the Omicron variant, it’s important not to lose sight of the currently over 7 million infections with Treponema pallidum worldwide. The WHO has set ambitious targets to reduce the incidence of syphilis by 90% by 2030!
At the start of this millennium, syphilis rates were so low that public health officials believed that the sexually transmitted infection was expected to be close to eradication. However, even with the availability of penicillin and safe sex education campaigns, rates in the US started growing again in 2001 and continued to increase steadily for the next two decades. From 31,618 reported cases in 2000, cases doubled to 63,454 in 2014, to 129,813 cases in 2019 nationwide according to the CDC.
In Florida, Health-care professionals are calculating an 85% increase in the number of residents who contracted syphilis in 2021, compared to 2020 (Escambia County/ Pensacola). In Texas, Lubbock County saw a nearly 300% increase in syphilis cases, Hockley County reports an increase of 1100% and Terry County an increase in 84% in 2022. In 2021, Pennsylvania, Planned Parenthood Keystone published an increase of about 158 % more cases of syphilis than in all three prior years. Allegheny County (including Pittsburgh) reported a 97% rise in primary and secondary (P&S) syphilis. The state of Washington reports a “record high” outbreak for the last 20 years in reported cases of syphilis. And the Wisconsin Department of Health Services reported in 2021 that cases had risen 300% in Milwaukee compared to pre-pandemic levels, with the biggest increase in women of child-bearing age.
Besides sexually transmitted infection, congenital syphilis through transmission from mother to baby during pregnancy or birth is assigned special medical relevance due to detrimental permanent consequences. Congenital syphilis can result in miscarriage, stillbirth, birth defects, or infant death. Though congenital cases are just a fraction of the country’s approximately 130,000 cases of syphilis, the rate has increased dramatically since 2012. During 2019, a total of 1,870 cases of congenital syphilis were reported, including 94 stillbirths and 34 infant deaths (141). The 2019 national rate of 48.5 cases per 100,000 live births represents a 41% increase relative to 2018 (34.3 cases per 100,000 live births) and a 477% increase relative to 2012 (8.4 cases per 100,000 live births).
Prevention of congenital syphilis relies on screening and treating pregnant women diagnosed with syphilis. The CDC recommendation for syphilis screening serologically at the 1st prenatal visit is mandated by most US states but nevertheless, in a CDC study of about 1300 cases of congenital syphilis reported nationwide in 2018, “missed opportunities” for prevention of congenital syphilis occurred. The most missed prevention opportunity among white mothers was lack of timely prenatal care (31.6%) whereas among black and Hispanic mothers, lack of adequate maternal treatment (37%) was the most common.
Sexual behavioral trends are key driving factors in the current resurgence of syphilis in the United States. Men having sex with men (MSM), HIV risk compensation, HIV coinfection, having multiple sex partners, increasing popularity of dating apps also known as Geospatial Network Applications, practicing unsafe sex, and illicit drug use overlapping with a lack of access to health care during the COVID-19 pandemic.
By Dr. Simone Müschenborn-Koglin Contributing Editor, GHP