Why Are Sexually Transmitted Infections Surging? (Published 2022)

Syphilis Diagnoses With Neurologic Involvement Increased From 2019 To 2022

Between 2019 and 2022, the prevalence of reported neurologic manifestations of syphilis increased across demographic groups in patients with early- and late-stage disease and among those with HIV infection, according to study findings published in Clinical Infectious Diseases.

Researchers conducted a review of national syphilis surveillance data captured from individuals aged 15 years and older that were reported to the Centers for Disease Control and Prevention (CDC) between 2019 and 2022. The researchers aimed to determine the prevalence of neurologic manifestations of syphilis reported over this period and the associated impact on overall disease burden, including the risk for severe complications.

Patients included in the analysis were stratified by stage of syphilis infection, with early-stage disease defined as diagnosis within 12 months of onset and late-stage disease defined as diagnosis more than 12 months after onset or as an unknown duration of disease. Neurologic manifestations were classified as 'verified,' 'likely,' or 'possible.' All classifications required confirmatory treponemal and non-treponemal testing as well documented clinical signs or symptoms suggestive of neurosyphilis with no other known causes indicated.

A total of 171,855 syphilis diagnoses were examined in the final analysis, of which 38.9% occurred in patients aged 25 to 34 years, 76.2% occurred in male patients, and 42.6% occurred in Black patients. The number of syphilis diagnoses evaluated accounted for 27% of the overall total reported to the CDC from 2019 to 2022. The researchers also noted annual syphilis rates increased during the study period (from 33,975 to 54,640).

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Early detection and treatment is crucial to prevent potential long-term neurologic sequelae of syphilis.

Although neurologic manifestations of syphilis were infrequently reported, the researchers noted they increased in prevalence over the study period for patients with early- and late-stage disease (from 0.6% to 1.0% and from 1.3% to 1.8%, respectively).

In patients grouped by age, the prevalence of neurologic manifestations in early-stage syphilis was approximately 7-fold higher among patients aged 65 years and older compared with those aged 15 to 24 years (prevalence ratio [PR], 7.5; 95% CI, 5.2-10.0). Moreover, the prevalence of neurologic manifestations in late-stage syphilis was more than 20-folder higher in patients aged 65 years and older compared with those aged 15 to 24 years (PR, 22.6; 95% CI, 16.8-30.6).

Factors associated with increased prevalence of neurologic manifestations in patients with any stage of syphilis included non-Hispanic White and non-Hispanic multiracial ethnicity. For early-stage syphilis, the prevalence was higher in men vs women (1.1% vs 0.7%). For late-stage syphilis, the prevalence was higher among men who reported sex with women (2.1%) and in men with available data on sex partners (2.0%) when compared with men who reported sex with both men and women (1.5%).

Compared with those with primary syphilis, the researchers observed higher prevalence of neurologic manifestations in patients with secondary syphilis (PR, 4.2; 95% CI, 3.3-5.3) and in those with late-stage syphilis or an unknown disease stage (PR, 5.2; 95% CI, 4.1-6.5). They also observed higher prevalence among patients with HIV vs without HIV infection for both early-stage disease (PR, 1.2; 95% CI, 1.0-1.4) and late-stage disease (PR, 1.5; 95% CI, 1.3-1.8).

Study limitations include the use of passive national case-based surveillance data, variations in neurologic screening and evaluation practices, the lack of clinical data beyond the presence or absence of neurologic manifestations, and potentially low generalizability. According to the researchers, "Healthcare providers should evaluate all patients with syphilis for evidence of neurologic signs/symptoms…" In addition, they noted "Early detection and treatment is crucial to prevent potential long-term neurologic sequelae of syphilis."

A New Truveta Study Offers A Hopeful Sign: Syphilis Incidence Is Down For The First Time In Decades

BELLEVUE, WA, April 15, 2025 (GLOBE NEWSWIRE) -- A new study published in the American Journal of Preventive Medicine spotlights a pivotal shift in syphilis transmission patterns across the United States, leveraging Truveta Data to deliver the most timely and comprehensive insights to date. The findings raise important considerations for public health leaders, clinicians, and policymakers working to curb the spread of sexually transmitted infections (STIs).

Syphilis is a preventable and curable sexually transmitted infection (STI). Left untreated, syphilis is associated with life-threatening complications – including brain damage, deafness, blindness, fetal death, and an increased risk of acquiring other sexually transmitted infections (STIs). The US Centers for Disease Control (CDC) has suggested that in 2022 the number of cases of syphilis infections reached its highest level since the 1950s, raising concerns about the transmission and the potential outcomes of untreated infections.

Using Truveta Data, the study analyzed real-world electronic health record data from over 56 million U.S. Adults between January 2017 and October 2024 and identified 21,180 first-time syphilis cases and tracked monthly incidence trends over nearly eight years.

Key findings:  Shifting demographics in US syphilis epidemic

The new study reveals a recent decline in syphilis incidence from its peak in 2022, a trend more pronounced among traditionally higher-burden groups including men, younger adults, those living with HIV, those living in the South, and individuals identifying as Black.

The positive findings are tempered by concerning trends. Prior to the recent decrease, syphilis incidence experienced substantial growth between 2017 and 2022, more than tripling among women and American Indian/Alaska Native individuals and more than doubling among those without recognized STI risk behaviors. These trends emphasize the necessity of renewed and precisely targeted public health interventions to address changing risk profiles in specific populations.

The results suggest a shift in transmission dynamics and underscore the urgent need for targeted education, testing, and treatment efforts in populations that may not traditionally see themselves at risk for syphilis.

"What's striking is that we observed a shift in trends over time. Overall, it's encouraging that we've seen a decline in syphilis incidence in the past two years. However, prior to that decline, between 2017 and 2022, we found a significant increase in incidence within lower-burden populations – women and those without behaviors associated with STI acquisition, PrEP use, or HIV. So, it's a complex picture: an encouraging recent decline, but a worrying earlier increase in a specific group," said Duy Do, PhD, principal applied research scientist, Truveta Research and lead author on the paper. "These findings highlight how dynamic the syphilis epidemic has become—and how important it is to adapt our public health strategies accordingly."

This study demonstrates the critical role data plays in advancing health equity and responding rapidly to shifting epidemiological trends.

"Syphilis is a preventable and treatable disease, but if left untreated, it can cause severe and lasting health problems," said Nick Stucky, MD, PhD, vice president of Truveta Research, practicing infectious disease physician at Providence Portland Medical Center, and an author on the paper. "This study shows how timely, representative real-world data can detect important shifts in public health trends so we can better understand not only where interventions are working—but where new risks are emerging and inform more targeted prevention, testing, and treatment programs."

This research was conducted using Truveta, which offers the most complete, timely, and clean regulatory-grade electronic health record (EHR) data from more than 120 million patients. Truveta Data is representative of inpatient and outpatient care from over 800 hospitals and 20,000 clinics. Truveta Data is updated daily for the most current view of patient care. By providing a complete view of the patient journey, including clinical notes and medical images, Truveta enables researchers to accelerate therapy adoption, improve clinical trials, and enhance patient care. These data were then analyzed using Truveta Studio, which enables scientifically rigorous, fast, and compliant analytics.

To learn more about Truveta, visit Truveta.Com.

About Truveta

Truveta is a collective of 30 US health systems with a shared mission of Saving Lives with Data. Truveta accelerates therapy adoption with regulatory grade safety and effectiveness data replacing slow and expensive clinical trials and registries. Truveta and its health system members lead the Truveta Genome Project, creating the world's largest and most diverse database of genotypic and phenotypic information to discover the science of humanity, accelerating discovery and improving patient care.

Truveta membership includes Providence, Advocate Health, Trinity Health, Tenet Healthcare, Northwell Health, AdventHealth, Baptist Health of Northeast Florida, Baylor Scott & White Health, Bon Secours Mercy Health, CommonSpirit Health, Hawaii Pacific Health, HealthPartners, Henry Ford Health System, HonorHealth, Inova, Lehigh Valley Health Network, MedStar Health, Memorial Hermann Health System, MetroHealth, Novant Health, Ochsner Health, Premier Health, Saint Luke's Health System, Sanford Health, Sentara Healthcare, Texas Health Resources, TriHealth, UnityPoint Health, Virtua Health, and WellSpan Health.

Truveta is a collective of 30 US health systems with a shared mission of Saving Lives with Data.

Surge In Virginia Syphilis Cases Alarms Physicians

A regional collaboration called the Stop Syphilis Coalition is launching a public awareness campaign this month to educate residents and providers on risk factors, symptoms and screening recommendations.

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Originally Published: April 2, 2025 at 1:22 PM EDT

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