EXECUTIVE SUMMARY

There are more reported cases of primary and secondary syphilis in the United States now than there have been in more than 20 years. The Centers for Disease Control and Prevention has issued a call to action to reverse the trend.

  • Current data show a 25% rise in syphilis rates among pregnant women from 2012 to 2014. After showing a decline from 2008 to 2012, statistics indicate a sharp increase, with the number of congenital syphilis cases in 2015 the highest since 2001. In 2015, there were 487 reported cases of congenital syphilis, for a national rate of 12.4 cases per 100,000 live births.
  • There also is a growing risk of syphilis among gay and bisexual men. Data indicate a 15% increase in the number of syphilis infections from 2013 to 2014 in this population.

There are more reported cases of primary and secondary syphilis in the United States now than there have been in more than 20 years.1 The Centers for Disease Control and Prevention (CDC) has issued a call to action to reverse the trend.

One troubling finding is a surge in congenital syphilis rates, say CDC officials. Concerns rise as a result of the consequences of untreated maternal syphilis infection, which range from preterm birth to fetal death, as well as congenital infection in some surviving infants. This infection can result in both physical and mental developmental disabilities.2

The CDC’s current data show a 25% rise in syphilis rates among pregnant women from 2012 to 2014.1 After showing a decline from 2008 to 2012, statistics indicate a sharp increase, with the number of congenital syphilis cases in 2015 the highest since 2001.1 In 2015, there were 487 reported cases of congenital syphilis, for a national rate of 12.4 cases per 100,000 live births.(Contraceptive Technology Update reported on the numbers; see “Syphilis Makes Dangerous Resurgence,” June 2016, available at http://bit.ly/2w9oECU.)

Research presented at the 2016 National STD Prevention Conference also indicates the growing risk of syphilis among gay and bisexual men. Data presented by CDC indicated a 15% increase in the number of syphilis infections in this population from 2013 to 2014 alone.3

The CDC plans to use both old and new prevention tools to protect the public from syphilis, said Gail Bolan, MD, director of CDC’s Division of Sexually Transmitted Disease Prevention, in a public call to health providers.

“We will, for example, improve surveillance; make a syphilis specimen repository available for technological developments; and help develop novel diagnostic tools and better prevention tools,” said Bolan. “At the same time, we will continue ongoing work to prevent all STDs, including syphilis.”

Use ‘Talk. Test. Treat.’

The CDC suggests that clinicians use the “Talk. Test. Treat.” approach with patients to help reduce syphilis rates.

  • Talking includes the act of taking routine sexual histories if the patient is having sex.
  • Testing includes screening patients for syphilis. The CDC recommends screening all sexually active men who have sex with men at least once a year, and more frequently if they are at higher risk for infection. All pregnant women should be tested at their first prenatal visit. Women at high risk for the disease should be rescreened early in their third trimester and again at delivery to prevent congenital syphilis. Other patients may need syphilis testing based on their sexual history.
  • Treating patients calls for giving an injection of long-acting benzathine penicillin G if someone tests positive for syphilis. Also advise infected patients to tell their sex partners so they may be tested and treated as well. Clinicians should report all cases of syphilis and congenital syphilis promptly to the state or local health department, the CDC advises.

Task Force Calls for Screening

The U.S. Preventive Services Task Force issued guidance in 2016 stating that screening for syphilis infection in asymptomatic, nonpregnant persons at increased risk for infection provides substantial benefit.4 The guidance updated previous recommendations issued in 2004; the task force issued separate recommendations on testing in pregnant women in 2009.5 That guidance reaffirmed the call for screening all pregnant women for syphilis infection.

According to the evidence reviewed by the task force, those at highest risk for syphilis infection include men who have sex with men and people living with HIV. In 2014, men accounted for 91% of all primary and secondary syphilis cases, and men who have sex with men accounted for 61% of cases.6

“Clinicians should also consider other relevant factors — including local infection rates, the patient’s sexual network, and the patient’s sexual risk behaviors — when deciding whether to screen for syphilis,” said Task Force member Ann Kurth, PhD, CNM, MSN, MPH, dean of the Yale School of Nursing and an adjunct professor in the New York University College of Nursing and the College of Global Public Health, as well as an affiliate faculty member in the University of Washington’s Department of Global Health and School of Nursing.

REFERENCES

  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016.
  2. Centers for Disease Control and Prevention. Congenital syphilis — United States, 2003-2008. MMWR Morb Mortal Wkly Rep 2010;59:
    413-417.
  3. de Voux A, Kidd S, Grey J, et al. Rates of primary and secondary syphilis by state among men who have sex with men — United States, 2014. Presented at the 2016 STD Prevention Conference. Atlanta; September 2016.
  4. U.S. Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, et al. Screening for syphilis infection in nonpregnant adults and adolescents: U.S. Preventive Services Task Force Recommendation Statement. JAMA 2016;315:2321-2327.
  5. U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009;150:705-709.
  6. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: Department of Health and Human Services; 2015.