Syphilis Rates Significantly Spike in Certain States

The leadership of the U.S. Health Resources and Services Administration (HRSA) recently announced increasing syphilis rates have been confirmed within American Indian / Alaskan Native (AI/AN) communities.

In partnership with the Indian Health Service (IHS), HRSA highlighted escalating syphilis rates within Alaska, Arizona, Montana, Nebraska, New Mexico, Oregon, and South Dakota on July 6, 2023.

As an example, syphilis rates in Alaska have risen annually since 2018, reported the state Health Department on August 1, 2023.

In Alaska, most cases have occurred in people who self-identify as heterosexual and live in urban environments such as Anchorage.

And about half of these syphilis cases were in women, and nearly 90% were of reproductive age.

Due to the rapidly rising syphilis and congenital syphilis (CS) rate, Alaska recommends increased perinatal testing to avert future cases. There were 12 CS cases reported in 2022. 

Alaska statute 18.15.150 maintains that pregnant women must be serologically tested for syphilis during their first prenatal care visit unless they refuse to test. An update to the recent CS Bulletin will be released to reflect this updated guidance: https://epi.alaska.gov/bulletins/docs/b2023_09.pdf.

Given the reach of HRSA programs and services across impacted communities, the agency requested utilization of the Centers for Disease Control and Prevention (CDC) sexually transmitted infections (STIs) screening and treatment guidelines to address this serious health issue among AI/AN communities.

Nationally, CDC data indicate that the rate of primary and secondary syphilis among AI/AN in 2021 was 42.2 per 100,000, nearly five times that of white individuals and up 520% from 8 per 100,000 among AI/AN in 2016.

In the same period, CS increased by over 900% among AI/AN (rate of 37.7 per 100,000 live births in 2016 compared to 363.7 in 2021) and is almost ten times higher than whites.

HRSA recommends that these communities adopt CDC recommendations for universal screening and testing for at-risk populations and follow state testing and treatment guidelines for syphilis and CS.

From a treatment perspective, the University of California, San Francisco, recently led a phase 4 clinical trial that concluded the combined incidence of syphilis was lower by two-thirds with doxycycline postexposure prophylaxis than with standard care.

Furthermore, AI/NA people experience disparities in pregnancy-related death and other maternal health conditions and are two times more likely to die of pregnancy-related causes than White women, says the U.S. CDC.

As of August 2, 2023, the U.S. FDA has not approved a syphilis vaccine candidate.

Other STI vaccines, such as HPV and mpox, have been approved to prevent diseases.