Nobody should be dying of syphilis in 2024. That’s the credo of Elizabeth Glaser, a public health nurse for the Indian Health Service, who drives thousands of miles throughout the Navajo Nation searching for community members with the infection. Once they’re found, Dr. Glaser administers shots of penicillin as treatment, at people’s homes, RVs, even in the back seat of her car.
Yet despite the good work of those like Dr. Glaser and the availability of cheap and effective treatment, the United States is experiencing rampant increases in syphilis. Left untreated, infection can lead to devastating neurological consequences such as blindness, deafness, madness and death. While other reportable sexually transmitted infections declined or remained flat during the pandemic, over 207,000 cases of syphilis were reported in 2022, an 80 percent increase since 2018 and the highest number reported since 1950.
Most disturbing within this trend is the rise in congenital syphilis. Over 3,700 cases were reported in 2022, which is more than double the number of cases of mother-to-child transmission of H.I.V. at the height of the AIDS crisis. Nearly 300 infected babies were stillborn or died in the first year of life.
How did we get into this situation? More important, how do we get out of it? The answers differ for each population most affected by the epidemic: pregnant women, and gay and bisexual men. To tackle congenital syphilis, we must cast off societal squeamishness about S.T.I.s and invest in proven control strategies: public education, testing, treatment and contact tracing. For gay and bisexual men, we need to embrace novel prevention interventions if we are to outwit this wily disease.
Syphilis is often referred to as the Great Masquerader: a painless genital ulcer or rash on the hands and feet are textbook signs, but a bloodshot eye, a white patch on the tongue or hair loss can be signs too. It can look like anything yet often looks like nothing, able to lie dormant for decades with no apparent symptoms.
But the surge in congenital syphilis isn’t due to the infection’s many disguises; it’s because of failures of our health system and safety net. According to the C.D.C., nine of 10 congenital syphilis cases in 2022 were preventable; lack of prenatal testing and timely treatment were the most common culprits, intersecting with social ills such as poverty, homelessness, substance use and incarceration. Because of systemic inequities, Indigenous, Pacific Islander and Black communities are hardest hit; one in 155 Native American births was affected by congenital syphilis in 2022.
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