Sexually transmitted diseases in adults continue to be a concern
The U.S. syphilis epidemic shows no signs of slowing down, with a new federal government report revealing a 9% increase in infectious cases in 2022. However, there is a silver lining: the rate of new gonorrhea cases has dropped for the first time in a decade.
Uncertain about the contrasting trends, officials at the U.S. Centers for Disease Control and Prevention (CDC) are unable to explain why syphilis continues to rise while gonorrhea declines. They emphasize the need for further analysis to determine if a downward trend for gonorrhea is emerging. Nevertheless, the CDC remains particularly concerned about syphilis due to its lesser prevalence but greater danger compared to gonorrhea or chlamydia.
The data released on Tuesday indicates that syphilis cases in 2022 reached a record high of over 207,000, the highest count in the United States since 1950. While gay and bisexual men continue to be disproportionately affected, syphilis is increasingly spreading among heterosexual men, women, and even newborns.
Understanding the Dangers of Syphilis
Syphilis is a bacterial disease that initially manifests as painless genital sores but, if left untreated, can lead to severe consequences such as paralysis, hearing loss, dementia, and even death. The introduction of antibiotics in the 1940s led to a significant decrease in new syphilis infections in the U.S., reaching their lowest point in 1998. However, approximately 59,000 of the cases reported in 2022 involved the most infectious forms of syphilis, with around a quarter of these cases affecting women and heterosexual men.
Dr. Philip Chan, a professor at Brown University and the chief medical officer of Open Door Health, a health center in Providence, Rhode Island, specializing in care for gay, lesbian, and transgender patients, suggests that syphilis may unknowingly be spreading in the heterosexual population due to inadequate testing and awareness.
Widespread Impact and Disparities
The report reveals that rates of the most infectious types of syphilis have not only increased across the country but also among different racial and ethnic groups. American Indian and Alaska Native people have the highest rate, with South Dakota leading as the state with the highest rate of infectious syphilis at 84 cases per 100,000 people—more than double the rate of the state with the second-highest occurrence, New Mexico.
Dr. Meghan O’Connell, the chief public health officer at the Great Plains Tribal Leaders’ Health Board in South Dakota, attributes the increase in syphilis cases to an outbreak in the Native American community. Most of the cases were reported in heterosexual individuals, and O’Connell explains that limited access to STD testing and treatment in isolated tribal communities was exacerbated during the pandemic.
Efforts to Combat the Epidemic
Recognizing the severity of the situation, the U.S. Department of Health and Human Services established a syphilis task force last year with a focus on curbing the spread of the STD in states with the highest rates, including South Dakota, 12 other states, and the District of Columbia.
The report also examined the more common STDs of chlamydia and gonorrhea. Chlamydia cases remained relatively stable from 2021 to 2022, maintaining a rate of about 495 per 100,000 individuals, although declines were noted among men and especially women in their early 20s. The most significant decline in gonorrhea cases was observed among women in the same age group.
Experts remain unsure about the decrease in gonorrhea rates, as it was observed across approximately 40 states. The disruption of STD testing during the COVID-19 pandemic may have contributed to the decrease in chlamydia rates in 2020. Dr. Jonathan Mermin, the director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, highlights the need to investigate this decline further and determine whether it is a continuing trend.
While the decline in gonorrhea cases is encouraging, the overall rate remains higher than pre-pandemic levels. As the CDC and other health agencies continue to grapple with the syphilis epidemic, comprehensive strategies and increased awareness are crucial in curbing the spread of these sexually transmitted diseases.
