Requested actions
- Be aware syphilis transmission is increasing among heterosexuals.
- Test all pregnant women for syphilis at their first prenatal visit.
- At 24-28 weeks gestation (early third trimester), re-evaluate for risk factors and test again for syphilis if any exist.
- Test the following people when they present for care (including at emergency departments):
- Sexually active and living homeless.
- Exchange sex for money or drugs.
- Use methamphetamine, heroin or cocaine.
- Report sexual exposure to someone with syphilis, even in the absence of signs or symptoms of infection.
- Treat as soon as possible people who:
- Have primary or secondary syphilis symptoms.
- Report sexual exposure to syphilis. Do not wait for test results.
Background
Syphilis cases continue to rise rapidly, and the increase is largely among presumed heterosexuals.
- Preliminary data suggest the incidence of early infectious syphilis (including early latent) has nearly doubled in 2021 vs. 2020 (35.1 cases per 100,000 vs. 19.4 per 100,000, respectively). This is a significant rise compared to previous years.
- The rate among Black/African American people appears to have more than tripled this year compared to 2020.
- The rate among presumed heterosexuals has more than doubled this year compared to 2020. The rate among men who have sex with men, while still higher, appears to be stable.
The rise in syphilis cases among heterosexuals—including pregnant women—has resulted in an increase in congenital syphilis. The number of cases among pregnant women is already higher than expected, as is the number of congenital syphilis cases. Congenital syphilis can cause:
- Miscarriage.
- Neonatal death.
- Preterm delivery.
- Long-term health problems in the affected child.
The congenital syphilis rate in the U.S. more than doubled between 2016 and 2018. Nationally, congenital syphilis most frequently occurs when women have very late or no prenatal care. We recommend testing all pregnant women for syphilis when they first seek prenatal care. At 24-28 weeks gestation (early third trimester), re-evaluate for risk factors and test again for syphilis if any exist. Test pregnant women not in routine prenatal care any time they engage with the healthcare system (i.e., emergency department, correction facility/jail, urgent care, other clinic visits).
Additional resources
- Our STD/HIV information for healthcare provider
- STD/HIV information—Washington State Department of Health.
- STD treatment guidelines, 2021—Centers for Disease Control and Prevention (CDC).
- Recommendations for providing quality STD clinical services—CDC.
- STD Clinical Consultation Network.