Why Are Syphilis Rates Rising, and How Can You Stay Safe Against This STD?

Syphilis is a common sexually transmitted infection that has been increasing over the last 20 years. In 2019, there were almost 130,000 new cases diagnosed. This is a dramatic change from just two decades ago. In 2000, the number of syphilis cases was so low that some public health officials thought it would soon be eliminated. Many people think of syphilis as a disease of the past, but the rising rates of syphilis show that’s not the case. 

If syphilis is caught early, it can be cured with antibiotics. Untreated syphilis can cause serious health problems, including irreversible damage to your heart, brain, and other organs. Syphilis can also be passed from pregnant people to their unborn babies. 

Here, we’ll review why the rates of syphilis have been increasing, who may be at greater risk for getting it, and how you can get tested and treated.

Where is syphilis most common, and who is at highest risk?

Syphilis has been on the rise since 2001, when it was at its lowest level ever. Since then, rates of syphilis have increased almost every year, including about 11% between 2018 and 2019.  

This increase includes all stages of syphilis and affects all genders, races, and ethnicities in all parts of the U.S. The rates of congenital syphilis (when it’s passed from a pregnant person to their child) have also increased by almost four times between 2015 and 2019. 

Anyone who is sexually active can get syphilis, but some groups may be more affected, including:

• Men who have sex with men (MSM) may be more likely to be diagnosed with early syphilis (primary and secondary).

• People (especially women) who use methamphetamine, inject drugs, or have sex with people who do.

• Congenital syphilis is more likely among American Indian or Alaska Native, Black, and Latino mothers. This is mainly due to not having access to prenatal care, including syphilis testing and treating. 

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Why have syphilis rates been rising?

There are many factors that could be contributing to the rise of syphilis rates:

• Decreased public health funding and resources for public STI clinics.  

• The increased popularity of dating apps, which may make it harder to track the spread of STIs and notify people who could have been infected.

• A decrease in condom use with the development of medications that can prevent HIV transmission, like pre-exposure prophylaxis (PrEP).

• Lack of prenatal care, which may be more likely if pregnant women are using drugs or homeless.

• A shift of people who used to work in syphilis and STIs now focusing on the COVID-19 pandemic.

• Syphilis reinfection is increasing and may not have as many symptoms, making it harder to diagnose.  

How is syphilis diagnosed?

Syphilis is usually diagnosed with blood tests that look for certain types of antibodies (proteins produced by your immune system when you have an infection).

It’s common to get a screening test first. If that’s positive, then another blood test is done to confirm the diagnosis. The tests are able to determine if you have an active infection or a past infection.

Examples of screening tests are:

• Venereal disease research laboratory (VDRL) test

• Rapid plasma reagin (RPR) test

• Rapid immunochromatographic test

Examples of tests that confirm a syphilis infection include:

• Fluorescent treponemal antibody absorption (FTA-ABS) test

• Enzyme immunoassay (EIA) test

• Treponema pallidum particle agglutination assay (TPPA)

It’s also possible to diagnose syphilis from a skin rash or sore, but this is less common. This is done by looking for syphilis bacteria in fluid or skin tissue using special microscopes.

Where can you get STD screening for syphilis?

There are many ways you can get tested for syphilis (and other STIs). Examples include: 

• Your provider’s office

• Community health clinics

• Clinics like Planned Parenthood

• Companies like STDcheck.com, where you order tests online and go to a testing center to get your blood drawn

• At-home STI test kits, which can be ordered online or picked up at some pharmacies

• Telehealth services like GoodRx Care

How is syphilis treated?

Syphilis is treated with an antibiotic called penicillin G benzathine. This kills the bacteria but doesn’t repair any damage that’s already been done, so getting treated early is important.

For people with early stages of syphilis, penicillin G is given as a single shot. If you have a later stage of syphilis or aren’t sure how long you’ve had it, penicillin G is given in three doses over three weeks. Providers use your symptoms and different tests to determine what stage of syphilis you have.

If you have a possible allergy to penicillin G, your provider may refer you to an allergist for allergy testing to see if penicillin G could be a safe option for you.

Can syphilis be cured?

Yes. If it’s caught and treated early, syphilis can be cured. 

Keep in mind that it’s possible to get reinfected with syphilis even if you’ve had it before and been treated. This may be more likely in men who have sex with men and who frequently change partners. A repeat syphilis infection may not have as many symptoms, so regular STI testing is important for all sexually active people.  

How can you avoid getting syphilis and other STDs?

Like with any STI, the most reliable way to keep from getting syphilis is to avoid having sex. But if you are or want to be sexually active, there are many steps you can take to lower your risk of infection: 

• Use a latex or polyurethane condom or internal condom every time you have anal, vaginal, or oral sex.

• Have fewer sexual partners.

• Practice mutual monogamy. This means you have only one sexual partner who agrees to be sexually active only with you, and you both make sure you don’t have an STI.

• Get screened for STIs regularly.

• Avoid substance use with alcohol or drugs before and during sex to avoid risky behavior.

• Get vaccinated in order to prevent other STIs, like hepatitis B, which has similar risk factors to syphilis and may be more likely to occur with it.  

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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