Syphilis cases quadruple on Long Island, U.S., in troubling sign for public health

Syphilis rates are rising sharply on Long Island and nationwide, causing severe illness for thousands of people across the country and leading to an increasing number of infant deaths.

Syphilis has been treatable for 80 years, and the spread of the bacterial disease reflects an underfunded public health system, reduced condom use and a lack of testing, experts say.

“We’re not doing a good job screening people, even people we think of being at high risk of being infected with syphilis,” Dr. Khalil Ghanem, a professor of medicine at Johns Hopkins University in Baltimore and immediate past president of the American Sexually Transmitted Diseases Association, told Newsday.

The number of Long Islanders newly diagnosed with early syphilis, when the disease is most infectious, more than quadrupled between 2011 and 2021, from 118 to 508, according to state Department of Health data.

Nationwide, there were nearly 177,000 newly reported syphilis cases in 2021, the most recent year available, compared with about 46,000 in 2011.

Ghanem said those numbers likely are significant underestimates because of undiagnosed cases.

Rates of the sexually transmitted diseases gonorrhea and chlamydia, which are more widespread than syphilis and can leave women infertile, also are rising, although less rapidly than syphilis, federal and state statistics show.

More than a third of syphilis cases nationally are among gay and bisexual men, and rates are much higher among Black and Native American people than among whites, Latinos and Asians, according to the Centers for Disease Control and Prevention.

“It’s here on Long Island, and it’s here in the city, and if you’re sexually active, it’s something to be screened for,” said Diane Bruessow, clinical lab director for the Bellmore-based LGBTQ group PFY, which is part of the Long Island Crisis Center and offers free syphilis testing.

National rates rising among newborns

Men are more likely to contract syphilis than women, but rates are rising more rapidly among women, CDC data shows. That has led to a tenfold increase in syphilis cases in newborns nationwide, from 335 cases in 2012 to 3,761 in 2022, a CDC report released Nov. 7 says. Of those 3,761 cases, known as congenital syphilis, 282 resulted in stillbirths or infant deaths, compared to 18 in 2012. The disease also can cause low birth weight, blindness, deafness, developmental delays and deformed bones in babies.

Lack of timely testing and adequate treatment were factors in nearly 90% of 2022 congenital syphilis cases, the CDC found. Nearly 38% of birth mothers received no prenatal care.

Treatment with benzathine penicillin G is up to 98% effective in preventing congenital syphilis, the CDC says.

“It’s a question of timely identification, and then it’s a question of appropriate treatment,” said Dr. Sharon Nachman, chief of pediatric infectious diseases for Stony Brook Medicine.

If the disease is found too late in pregnancy, even with treatment there’s a risk of transmission to the baby, she said.

A nationwide benzathine penicillin shortage may exacerbate the increase in congenital rates, although most hospitals in New York have guidelines to reserve use of the medication for pregnant women, Nachman said.

New York requires syphilis testing during the first prenatal exam, and at delivery. A new law that goes into effect in May requires an additional test at 28 to 32 weeks of pregnancy, because of the possibility of contracting syphilis after the first exam.

The new requirement may help prevent some congenital syphilis cases, said Martine Hackett, chair of population health and director of public health programs at Hofstra University.

But, she said, “If people who are pregnant are not going into prenatal care, these new testing timelines will not be sufficient … These are people who are disconnected from the health care system.”

New Yorkers are more likely to receive prenatal care than in many other states, because of broader Medicaid coverage, and that may be why syphilis rates among newborns are lower in New York, Hackett said.

New York’s 2021 rate of congenital syphilis — 19.5 per 100,000 live births — is nearly four times lower than the nation’s, even though the state is slightly above the national rate for early primary and secondary syphilis.

Nassau and Suffolk each had a single congenital syphilis case in 2021; there were 41 statewide, up from 29 in 2020, state data shows.

Federal syphilis funding cut 

Amid the growing syphilis rates, federal funding to combat the disease is being cut. As part of the debt ceiling negotiations in June, Congress rescinded $400 million of $1 billion to hire additional STD program employees. That led some states to cut their STD budgets, although spokespeople for the New York, Nassau and Suffolk health departments said their STD budgets have not been reduced and that health care workers still search for and notify partners of those who test positive for the disease.

Hackett said the reduction in STD allocations “indicates a lack of urgency” in combating STDs and may reflect the stigma surrounding sexually transmitted infections, making it politically easy to slash funding.

Over the past two decades, federal STD funding has been cut 40%, taking into account inflation, said Elizabeth Finley, spokeswoman for the National Coalition of STD Directors, which represents state, territorial and city STD directors and is calling for $1 billion in additional STD funding.

Syphilis plummeted after penicillin

Syphilis, which may date back thousands of years, once was a much more common and dangerous disease because of lack of effective treatment.

Vincent Van Gogh, Ludwig van Beethoven, Friedrich Nietzsche and various kings are among those believed to have had syphilis, and some, like Al Capone, are believed to have died from complications of the disease, according to a history of syphilis published in the Journal of Medicine and Life.

Left untreated, syphilis can cause blindness, brain damage, strokes, deafness and other serious medical problems, most of which stem from damage to the central nervous system, Ghanem said. In 2021, an estimated 5,100 to 8,600 Americans were newly diagnosed with serious nervous system complications from syphilis, according to a study Ghanem co-authored that was published in August in the journal Clinical Infectious Diseases.

Syphilis rates plummeted after penicillin was first used to treat syphilis in 1943, falling from more than 575,000 cases in 1943 to 31,618 in 2000.

By the late 1990s, optimism was widespread that syphilis could be eradicated, Ghanem said, and in 1999, the federal government released a plan to eliminate syphilis.

Then rates began rising, and in 2013 the government abandoned the effort.

Decreased condom use a factor

In addition to less funding, decreased condom use because of less concern about HIV infection — amid treatments and medications that prevent transmission — is contributing to higher syphilis rates, Bruessow said.

Also, some people who used condoms for birth control no longer are doing so because of increased use of birth control methods like IUDs, for which the Affordable Care Act now requires insurance coverage, Finley said.

Increased injection-drug use may be a factor as well, because syphilis can be spread through needles, she said.

Ghanem said that “if you throw enough money at this problem,” syphilis rates will fall.

Yet although an increasing number of babies and adults develop serious health complications from syphilis every year, there is not yet a commitment to do so, he said.

“When we start believing as a society that these rates are unacceptable, then we're going to have to increase funding for aggressive public health measures to control this infection,” he said.