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  • Presentation

Syphilis Update 2025

Description

The 2025 syphilis update provided a comprehensive overview of the current epidemiology, clinical presentations, and treatment strategies concerning syphilis in the U.S. After a major decline in prevalence post-World War II due to penicillin, syphilis rates began rising again in the 2010s, culminating in a sharp spike around 2020. Recent trends show a slight decrease in cases observed from 2022 to 2023, particularly among men, with a notable increase in infections among women, especially in vulnerable populations like Native Americans. The talk highlighted various clinical manifestations of syphilis, including both typical and atypical presentations, emphasizing the importance of recognizing symptoms across different demographics. Diagnosis and treatment strategies were discussed, including the differences between treponemal and non-treponemal tests, the significance of timely treatment, and emerging preventive measures such as doxycycline post-exposure prophylaxis (doxy PEP). Further, it was noted that some public health strategies previously in place to combat syphilis were weakened due to the shift of health workers' focus to COVID-19, potentially exacerbating the epidemic. Clinicians were urged to remain vigilant, continually assess their patients' sexual health needs, and screen for syphilis given its rising prevalence and the associated health disparities.

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Conclusions

  • Syphilis rates in the U.S. have significantly increased since 2020, with a recent stabilization noted between 2022 and 2023.
  • A disproportionate increase in syphilis cases is observed among women, particularly impacting certain population groups like Native Americans.
  • The COVID-19 pandemic disrupted STD prevention efforts, leading to an increase in syphilis cases due to resource reallocation to pandemic response.
  • Recent strategies such as Doxy PEP for high-risk individuals may be contributing to the decline in syphilis case rates in 2023.
  • Neurosyphilis can present at any stage of syphilis, necessitating awareness in diagnostics and treatment protocols.
  • Clinical presentations of syphilis are becoming more atypical, complicating diagnosis for healthcare providers.
  • Structural factors such as homelessness, lack of access to healthcare, and substance use disorders are significant social determinants affecting syphilis rates.
  • Congenital syphilis remains a serious concern, with rising cases leading to significant infant mortality and morbidity.
  • Cossman, J. P., & Fournier, J. B. (2017). Frequency of syphilis diagnoses by dermatologists. JAMA Dermatology, 153(7), 718-719. doi:10.1001/jamadermatol.2017.0460
  • Bachmann, L. H., Barbee, L. A., Chan, P., Reno, H., Workowski, K. A., Hoover, K., Mermin, J., & Mena, L. (2024). Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States. Morbidity and Mortality Weekly Report, 73(2), 1-8.
  • JAMA Dermatology. (2022). Resurgence of Syphilis in the US-USPSTF Reaffirms Screening Guidelines. 158(11).
  • JAMA. (2022). January 11; 327(2).