Art historians say the most famous painting of congenital syphilis is “The Inheritance” by Norwegian expressionist painter Eduard Munch, who in 1899 shocked European audiences by showing a young mother in tears holding an infant to whom she had given the infection.
Just 50 years later, newly invented antibiotics helped bring down surging rates of the old foe so effectively that it was nearly eliminated in Americans by the 1990s. But once again, rates of syphilis are skyrocketing, reaching levels not seen since the 1950s. And that’s alarming health experts from around the country, who met last week in downtown Atlanta to find new ways to eradicate the ancient health threat.
Credit: Munchmuseet
Credit: Munchmuseet
The Centers for Disease Control and Prevention (CDC) is confident that new medicines and quick tests can stem the spread of this old infection. But communities around the nation need to talk openly about the surge in sexually transmitted diseases (STDs) as a first step to bringing down rates of syphilis, gonorrhea and chlamydia in the United States, the CDC’s new point person for STDs said.
“We have a tremendous problem,” Dr. Bradley Stoner, director of CDC’s Division of STD Prevention, told The Atlanta Journal-Constitution. “In 2022, we had more than 2.5 million cases of syphilis, gonorrhea and chlamydia diagnosed. There’s a tremendous amount of work to do, and all of that work is being done at the local level.”
The syphilis surge is most alarming, Stoner said, because a pregnant woman who has syphilis can pass it to her fetus, leading to the infant being stillborn in 40% of cases or suffering grave birth defects if it survives. This is entirely preventable if a pregnant woman is tested and cured of syphilis with one penicillin shot given at least 30 days before delivery. The CDC and local governments have found that treating a syphilitic baby after birth is extremely costly for U.S. health care systems, because the sick child will incur three times higher medical expenses than one born without, and face a lifetime of severe health problems.
In Georgia last year, 127 babies were born with congenital syphilis, and of that number, 16 died in utero and were delivered stillborn, according to the Georgia Department of Public Health. Congenital syphilis rates are now six times higher than in 2016, when 21 babies in Georgia were born with the condition.
In 2020, stillbirth occurred among Black women two times more often than among white, Asian or Pacific Islander women, according to the CDC.
Credit: Photo provided by the Ce
Credit: Photo provided by the Ce
The CDC reported 207,255 total syphilis cases in the U.S. in 2022 — an 80% increase since 2018.
Syphilis in Georgia stood at 7,225 cases in 2022, up 9% from the previous year. Cases have risen 200% since 2012, according to the Georgia Department of Public Health’s Oasis database.
Georgia has significantly higher numbers of babies born with syphilis compared to New York, Virginia and Massachusetts, which had some of the lowest rates, but the state is in the middle of the pack compared to U.S. states overall.
Stoner, who joined the CDC on July 28, and was previously chief of STD services in St. Louis, and a visiting medical officer at the World Health Organization, says syphilis prevention programs in Baltimore and New York City could be a model for the rest of the country.
And he thinks self-testing efforts will be a key tool in fighting a virus that has been a scourge on human health since at least the 15th century.
Last month, the U.S. Food and Drug Administration authorized the first at-home syphilis test by NowDiagnostics. The test delivers results in 15 minutes with a single drop of blood from a fingertip. Stoner said the test will be a game changer if women exposed to syphilis can access it, and then connect to care.
In Georgia, pregnant women in need of STD screening and other prenatal care can access it for free for up to 12 months after giving birth, via the state’s Medicaid for Pregnant Women program.
“Community awareness and community engagement can go a long way. Public health can’t do it by ourselves: we need to continue to raise awareness,” Stoner said.
New medications block spread of STIs
Stoner is also optimistic that drug treatments known as pre- and post-exposure prophylaxis can stop the spread of HIV and slow the spread of infections like syphilis, gonorrhea and chlamydia. Taken before or after sex, the drugs can prevent an infection.
For HIV, the CDC and health agencies around the U.S. are promoting the use of PrEP drugs or pre-exposure prophylaxis for HIV-negative men who have sex with men, trans people and at-risk women. HIV-negative individuals can take the PrEP drugs as a daily pill, on demand, or via an injectable form given every other month, in order to remain HIV negative. A program at Grady Hospital can enroll people who lack insurance at no cost to patients, the AJC reported in August.
PrEP reduces the risk of getting HIV from sex by about 99%, the CDC said.
The U.S. became a global leader in approving new drugs for use as PrEP when the FDA gave the green light to the first HIV-blocking drugs 12 years ago. Yet persistent inequality in access has meant that Black people, Hispanic people, and people living in the U.S. South have not been able to access the medicines at levels needed to drive down new HIV infections, according to a study published in May in the Lancet medical journal.
Metro Atlanta has the third-highest HIV rate in the U.S., according to the CDC. The burden hasn’t been spread equally: 74% of new HIV cases in 2021 were among Black Atlantans.
A second intervention, known as DoxyPEP, or post-exposure prophylaxis, involves taking the drug doxycycline after exposure to block an infection. If taken within 72 hours after sex, it was shown in three trials to reduce syphilis and chlamydia infections by over 70%, and gonorrhea infections by approximately 50%.
Moreover, a cost-effective and rapid test by Binx Health promises results for gonorrhea and chlamydia in 30 minutes, allowing for quick treatment via a growing network of testing sites across the U.S., TerriAnn Bostocky from Binx Health told the AJC.
CDC studying British vaccine proposal to cut gonorrhea
The CDC is also looking overseas at a novel use of a meningitis B vaccine to cut rates of gonorrhea.
Last November, an expert panel that advises the United Kingdom on vaccine policy recommended using GSK’s Bexsero meningitis B vaccine to try to bring down spiking rates of gonorrhea there. If adopted, the U.K. would be the first country to use the meningitis B vaccine for this purpose, Statnews reported.
The vaccine for meningitis B is effective against gonorrhea because Neisseria meningitidis and Neisseria gonorrhoeae share between 80% and 90% of their genetic sequence, according to a study published in the Lancet.
A study of young people in New York City and Philadelphia found that Bexsero was 40% effective in preventing gonorrhea, while a case control study of gay and bisexual men with HIV in Italy showed a vaccine effectiveness of 42%. A matched cohort study of young people in southern California showed 46% vaccine effectiveness, Aidsmap reported.
Dr. Stoner said all of these interventions will help and should be evaluated on a case-by-case basis between a doctor and a patient. He also stressed the continued importance of condoms as a simple and cost-effective method of preventing STIs and pregnancy.
“I see all of these interventions – DoxyPEP, condoms, Bexsero, HIV PrEP – as part of a larger toolkit that we can use for prevention,” he said.
How to prevent, test, and treat STIs in Atlanta
How to get PrEP and DoxyPEP:
Fulton and DeKalb county residents: Visit: www.gradyhealth.org/get-prep-hiv-prevention-pill/ to book appointment. Call: 404-616-7737. Email: getPrEP@gmh.edu. Walk in: Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303
Cobb County residents: Visit: https://cobbanddouglaspublichealth.com/services/hiv/hiv-prevention/, click “Make an Appointment,” scroll down to Sexual Health Services, click “PrEP Initiation,” or call: 770-514-2300
Gwinnett County residents: Visit: https://www.gnrhealth.com/services/community-health/prep/. Call: Contact PrEP coordinator at 770-339-4283 Ext. 420 or our HIV program manager at 678-442-6897 Ext. 135.
Order a free, at-home HIV test from Together TakeMeHome, a collaboration between Emory University and the CDC.
Order free condoms online, or pick up free condoms in Atlanta by visiting Positive Impact Atlanta’s website.
Free Condoms by Mail from Fulton County Board of Health
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