The syphilis pandemic in the United States does not subside and, on the contrary, the rate of infectious cases increased by 9% during 2022, according to a new report from the federal government on sexually transmitted diseases (STDs) in adults.
But there is some good — and unexpected — news: The rate of new gonorrhea cases fell for the first time in a decade.
It is not clear why syphilis cases increased by 9% while gonorrhea cases fell by 9%, officials at the US Centers for Disease Control and Prevention (CDC) said. They added that it is too early to determine if there is a new downward trend for the latter.
They are more concentrated in syphilis, which is less common than gonorrhea or chlamydia but is considered more dangerous. Total cases surpassed 207,000 in 2022, the highest in the United States since 1950, according to data released Tuesday.
And while it continues to have a disproportionate impact on gay and bisexual men, the disease is spreading to heterosexual men and women, and is also increasingly affecting newborns, according to CDC officials.
Syphilis is a bacterial disease that can manifest itself in the form of genital ulcers that do not cause pain but, if left untreated, can cause paralysis, hearing loss, dementia and even death.
The number of new infections in the United States began to fall starting in the 1940s, when antibiotics became widely available, and reached its lowest level in 1998.
About 59,000 of the 2022 cases involve one of the most infectious forms of syphilis. Of these, approximately a quarter were in women and a similar proportion in heterosexual men.
“I think it’s spreading unknowingly among the cisgender heterosexual population, because we’re not really testing for it. We’re not really looking for it” in that population, said Dr. Philip Chan, a professor at Brown University and director of medicine at Open Door Health, a health center for gay, lesbian and transgender patients in Providence, Rhode Island.
The report also shows that rates of the most infectious types of syphilis not only increased nationwide, but also among different racial and ethnic groups, with American Indians and Alaska Natives having the highest rate. South Dakota was the state with the highest rate of infectious syphilis, with 84 cases per 100,000 residents, more than double that of the next state on the list, New Mexico.
The increase in South Dakota was due to an outbreak in the Native American community, said Dr. Meghan O’Connell, public health director for the Great Plains Tribal Leaders Health Board, based in Rapid City, Dakota. South. Almost all cases were in heterosexual people, and O’Connell said testing and treatment for sexually transmitted diseases was already limited in isolated tribal communities and the situation only worsened during the pandemic.
The U.S. Department of Health and Human Services last year convened a syphilis task force focused on stopping the spread of this STD, focusing on places with the highest rates: South Dakota, 12 other states and the District of Columbia.
The report also looked at the most common STDs such as chlamydia and gonorrhea.
Chlamydia cases remained relatively stable between 2021 and 2022, with a rate of around 495 per 100,000, although declines were seen in men and especially women between 20 and 30 years old. In the case of gonorrhea, the most pronounced decline was also recorded in women within that same age range.
Experts say they aren’t sure why gonorrhea rates declined. This occurred in about 40 states, so whatever explains the decline appears to have occurred in most of the country. STD testing was halted during the COVID-19 pandemic, and officials believe that’s why the chlamydia rate dropped in 2020.
Testing and diagnostics may continue to be adjusted in 2022, said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention.
“We are encouraged by the magnitude of the decline,” Mermin said, although the gonorrhea rate remains higher now than before the pandemic. “We have to examine what has happened and whether it will continue to happen.”
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