Sexually Transmitted Infections Surveillance, 2022

Dear Partners in Prevention,

Today, CDC released Sexually Transmitted Infections (STI) Surveillance, 2022. The annual report – which highlights that the syphilis epidemic continues to escalate – underscores that STIs must be a public health priority.

Overall, in 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States.

According to the report, syphilis cases (all stages and congenital syphilis) have increased 80 percent in the past five years. More than 3,700 congenital syphilis cases were reported in 2022, reflecting an alarming 937 percent increase in the past decade.

While reported syphilis cases continued to increase, reported chlamydia cases were level and reported gonorrhea cases declined by nearly 9 percent in 2022. Given this is the first drop in reported gonorrhea cases in at least a decade, we are examining this finding closely and will be looking to 2023 data to better understand if this signals a true decline in infections, or if this is related to changes in gonorrhea diagnoses and reporting in 2022. Although gonorrhea declined, this finding may be a cause for an even closer look at public health efforts and redoubled prevention strategies, including those that improve access to STI testing and treatment.

U.S. syphilis epidemic continues to climb – we must stop syphilis in babies

The U.S. syphilis epidemic worsened yet another year, and swift action is urgently needed to slow the curve. Cases of primary and secondary (P&S) syphilis—the most infectious stages of the disease—increased 10 percent in 2022 alone and 68 percent since 2018.

Steady growth in P&S syphilis among women fuels the congenital syphilis epidemic, threatening the health of babies. Building on a decade of increases, reported congenital syphilis cases increased 31 percent in just one year, from 2021-2022. Nearly every state reported having at least one congenital syphilis case. Some states are feeling the impact more than others – Texas, California, Arizona, Florida, and Louisiana represented 57 percent of all reported congenital syphilis cases. Tragically, these infections resulted in 282 stillbirths and infant deaths in 2022.

Racial and ethnic minorities continue to be disproportionately affected. The highest number of cases occurred among those who are Black or African American, Hispanic and Latino, and White. American Indian or Alaska Native people experienced the highest rate of congenital syphilis—for every 155 births in 2022, there was one congenital syphilis case. Black or African American people experienced about 30 percent of congenital syphilis cases in 2022. As disparities persist among some groups, it is evident that our nation must keep striving to address longstanding social inequalities that often lead to health inequalities and, ultimately, health disparities.

CDC’s recent Vital Signs report, Missed Opportunities for Preventing Congenital Syphilis — United States, 2022, showed that timely syphilis testing and treatment during pregnancy might have prevented almost 9 in 10 (or 88%) congenital syphilis cases in 2022.

Collaboration is key in reversing the STI epidemic

The STI field has reached a tipping point. We have long known that these infections are common, but we have not faced such severe effects of syphilis in decades. Recent public health emergencies diverted program resources and threatened the health of those already disproportionately affected by STIs. We must move now to pick up the pieces.

We cannot continue to use decades-old prevention strategies to address today’s STI epidemic. People need testing and treatment to meet them where they are. We know treatment is not always received in traditional healthcare settings. We must continue supporting opportunities and initiatives that enhance and expand STI service delivery, care, monitoring, research, and training. Innovative solutions like partnerships with retail health or pharmacies, STI express clinics, and setting up injectable syphilis treatment delivery programs can jump-start care for people. CDC is working quickly to offer final guidance on the use of doxycycline post-exposure prophylaxis to prevent bacterial STIs. This is the first major bacterial STI prevention innovation in decades.

Within the STI epidemic, syphilis is one infection that stands alone. It has emerged as a unique public health challenge. We are calling on all partners, particularly healthcare providers, to understand who should be tested for syphilis in their community, talk with patients about sexual health, treat patients and their partners immediately, and work with local and state health departments to improve syphilis management and access to care. Every case is one too many when we have the tools to prevent it. We must find a way to apply the tools we have more effectively and acknowledge that innovation is overdue and new primary prevention strategies are now necessary. We urgently need better tools for immediate diagnosis and new treatment options.

We are encouraged as the U.S. Department of Health and Human Services mobilizes the first-ever National Syphilis and Congenital Syphilis Syndemic Federal (NSCSS) Task Force. The NSCSS Task Force is a cohesive, coordinated response among federal agencies and external partners to help move syphilis prevention forward. Together, partners seek to address the syndemic of syphilis and congenital syphilis, reduce their rates, promote health equity, and share resources with affected communities.

We are grateful for the continued collaboration of our STI prevention partners and look forward to supporting partners outside of our field as we collaboratively mobilize to turn the tide on the STI epidemic.

Best regards,

Laura Bachmann, MD, MPH, FIDSA, FACP
Acting Director, Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
US Centers for Disease Control and Prevention