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Review
. 2019 Oct 16:12:1178633719883282.
doi: 10.1177/1178633719883282. eCollection 2019.

Resurgence of Syphilis in the United States: An Assessment of Contributing Factors

Rebecca Schmidt  1 , Paul James Carson  1   2 , Rick J Jansen  1   2   3   4
Affiliations
Review

Resurgence of Syphilis in the United States: An Assessment of Contributing Factors

Rebecca Schmidt et al. Infect Dis (Auckl). .

Abstract

In the last decade, there has been a marked resurgence of syphilis in the United States despite the availability of effective treatments and previously reliable prevention strategies. The majority of cases are among the population of men who have sex with men (MSM); however, there has also been a recent increase among premenopausal women, coinciding with a concerning rise of congenital cases. The resurgence of syphilis can be largely attributed to changing social and behavioral factors, especially among young MSM. The biological association of syphilis with human immunodeficiency virus (HIV) transmission and acquisition is particularly alarming because of the increased individual and healthcare burden. In addition, some individual actions and public health efforts that are meant to reduce the risk of acquiring HIV may actually lead to risk compensation that facilitates the transmission of syphilis. Untreated syphilis is associated with detrimental health outcomes; therefore, both effective prevention strategies and treatment of this systemic disease have important short-term and long-term public health implications. This article offers a review of social and behavioral factors contributing to the current resurgence and recommendations for reducing syphilis incidence through medical and public health prevention strategies.

Keywords: HIV coinfection; HIV risk compensation; Illicit drug abuse; men who have sex with men; sexual behavior; sexually transmitted infection; syphilis incidence.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Incidence of primary, secondary, and congenital syphilis rates 2000-2017. Adapted from the CDC’s Sexually Transmitted Disesease Surveillance Report.
Figure 2.
Figure 2.
Primary and Secondary Syphilis-Reported Cases by Sex, Sexual Behavior, and HIV Status, United States, 2017. Obtained from the CDC STD Surveillance website (https://www.cdc.gov/std/stats17/figures/46.htm). MSW indicates men who have sex with women; MSM, men who have sex with men.
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