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

Rebecca Schmidt; Paul James Carson; Rick J Jansen

doi:10.1177/1178633719883282

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

Infect Dis (Auckl). 2019 Oct 16:12:1178633719883282. doi: 10.1177/1178633719883282. eCollection 2019.

Authors

Rebecca Schmidt¹, Paul James Carson^{1

2}, Rick J Jansen^{1

2

3

4}

Affiliations

¹ Department of Public Health, North Dakota State University, Fargo, ND, USA.
² Center for Immunization Research and Education, North Dakota State University, Fargo, ND, USA.
³ Biostatistics Core Facility, North Dakota State University, Fargo, ND, USA.
⁴ Genomics and Bioinformatics Program, North Dakota State University, Fargo, ND, USA.

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.

Publication types

Review