CDC Call to Action

Let’s Work Together to Stem the Tide 

of Rising Syphilis in the United States

April 2017
CONTENTS

OVERVIEW 3

ACTIONS FOR SPECIFIC POPULATIONS 6

Pregnant Women 6

Gay, Bisexual, and Other Men Who Have Sex with Men 6

Health Care Providers 7

Public Health Departments 8

Decision-makers and Community Leaders 9

Biomedical Scientists 

Universities and Industry 9

Electronic Medical Record Developers 9

Electronic Medical Record Vendors  

INFOGRAPHIC: New Tools Are Needed for Syphilis Prevention and Control 10

WHAT CDC WILL DO 12

SOURCES 12

CALL TO ACTION: Syphilis rates are increasing among 

women and their babies, and men throughout the United 

States. Untreated syphilis can cause severe medical issue

Efforts are needed to create new tools to detect and treat 

syphilis, increase testing, control the further spread of 

syphilis, and improve electronic medical records in order 

to improve patient outcomes

The U.S. Centers for Disease Control and Prevention’s Division of STD Prevention provides national leadership; funds an

works with state, territorial and local STD programs; conducts program research and evaluation; and disseminates scientific 

information to prevent STDs and their complications

2
OVERVIEW

Primary and Secondary Syphilis—Rate of Reported Cases by Sex, 

United States, 1990−June 2016*

*Data for Jan-June 2016 are preliminary, as of March 30, 2017

Rates per 100,000 population.

Syphilis Is Preventable and Treatable

Syphilis is a sexually transmitted disease that can have very 

serious complications when left untreated, but it is simple to 

prevent and can be cured with the right treatment. Penicillin 

has been used to treat syphilis since 1943 and remains the 

best drug for treating the infection. When not adequately 

treated, syphilis can lead to visual impairment, hearing loss, 

stroke, and other neurological problems. Syphilis infection 

can also increase a person’s risk for getting HIV or giving 

it to others. All 50 states require that syphilis cases be 

reported to the state or local public health agency so that 

it can take action to find and treat exposed persons. This 

prevents others from becoming infected and also prevents 

the adverse health outcomes of untreated syphilis.

Syphilis Rates Are Increasing in Men, 

Women, and some Newborns

Recent data show that syphilis rates are on the rise. 

Rates of primary and secondary (P&S) syphilis—the most 

infectious stages of the disease—increased a troubling 19% 

between 2014 and 2015. Preliminary data show a similar 

rate of increase in the first 6 months of 2016.

While rates have increased among both men and women, 

men account for more than 90% of all P&S cases. Gay, 

bisexual, and other men who have sex with men (MSM) 

account for 82% of male cases where the sex or gender of 

the partner is known. 

Likewise, increases in congenital syphilis (CS) have paralleled 

the national increase in P&S syphilis among women of 

reproductive age. CS, which can cause miscarriage, stillbirth, 

early infant death, or severe illness in those infants who 

survive, increased each year from 2012 through 2015. 

Preliminary data show further increases in 2016. A pregnant 

woman with untreated syphilis can infect her fetus through 

the bloodstream during any stage of syphilis. 

CDC is working with other federal agencies 

and national partners to reverse increasing 

trends of both congenital syphilis and 

syphilis among MSM. To achieve these goals, 

CDC needs the support of various sectors 

of society, including health care providers, 

public health departments, decision-makers, 

academic institutions, researchers, industry, 

and, most importantly, those members of 

society who are at higher risk.

3
Percent change in syphilis* rate from 2011 to 2015

2011-2015 US 

percent change 

in syphilis: 

67% 

increase

*primary and secondary

**these states had 0 cases in 2011

-27% – 0%: AK, VT 1% – 50%: WA, TX, MS, AL, TN, KY, SC, IL, OH, WI, MI, MD, DE, CT 51% – 100%: CA, MT, CO, NM, LA, FL, MN, IN, NY, PA, VA, MA, RI 

101% – 200%: NV, AZ, AK, OK, MO, GA, NC, NH, ME 201%+: OR, ID, UT, WY, ND, SD, NE, KS, IA, WV, HI

The United States Needs New Tools 

for Syphilis Prevention and Control to 

Supplement Those in Use Since the 1940s 

Fortunately, penicillin still works to treat syphilis. However,

it is the only known antibiotic to treat syphilis during 

pregnancy. So for pregnant women with a severe allergy

to penicillin, or when there is a drug shortage, there are no 

alternative treatment regimens to turn to. The rest of our

treatment and prevention tools are outdated

The most commonly used tests require at least two

sequential antibody tests in blood and do not confirm 

active syphilis infection. These blood tests are cumbersome,

hard to interpret, unable to diagnose early infections and

may lead to treatment delays. Tests to directly detect the

presence of syphilis-causing bacteria in lesions by complex 

microscopy or nucleic acid amplification tests (NAATs) are 

not widely available. There is a critical need for commercially

available direct detection tests and modernized blood test

development looking at specific proteins or genetics-based

technologies to detect active infection.

Treatment options need to be expanded, especially for 

pregnant women, CS, ocular syphilis, and neurosyphilis

Research is also needed to better identify the stage of 

disease and determine appropriate management of 

syphilis, factors associated with the development of 

neurosyphilis and ocular syphilis, and treatment for syphilis 

disease in individuals living with HIV

There is no syphilis vaccine, despite early work 

demonstrating that vaccination could potentially protect 

from syphilis disease. Additionally, very few biomedical

scientists have entered the field, and in the 21st century 

many clinicians are not familiar with the appropriate 

diagnosis and management of syphilis

Screening and Treating Women with Syphilis 

Can Prevent Congenital Syphilis

There has been a sharp increase in the number of babies 

born with CS in the U.S., despite CDC recommendation

that all pregnant women get tested for syphilis at their 

first prenatal visit. After a steady decline from 2008 to

2012, cases of CS increased by 46% between 2012 and 

2015, and preliminary data suggest that CS increased 

again in 2016. This increase parallels a nationa

increase in P&S syphilis among women of 

reproductive age during the same time period

4
Congenital Syphilis (CS) Rate and Rate of Primary and Secondary (P&S) Syphilis 

Among Females Age 15-44 Years, 2008 - June 2016*

*Data for Jan-June 2016 are preliminary, as of March 30, 2017

CS rate per 100,000 live births; female P&S rate per 100,000 women

A pregnant woman with untreated syphilis can infect her 

fetus through the bloodstream at any stage of syphilis. U

to 40% of babies born to women with untreated syphilis 

may be stillborn or die from the infection as a newborn

Infants born with CS might have health problems, 

including skin rashes, yellowing of the skin or whites of 

the eyes (jaundice), enlarged liver and spleen, or severe 

anemia. Untreated babies that survive the newborn period

can develop problems later on, such as developmental 

delays and bone and joint abnormalities

The resurgence of CS points to missed opportunities for 

prevention. One quarter of CS cases are due to a lack

of prenatal care. But even among those receiving some

prenatal care, the detection and treatment of maternal 

syphilis often occur too late to prevent CS. Of women who

gave birth to an infant with CS, 42% were not tested in 

time to be treated to prevent CS

Syphilis Screening Needs to Increase among 

Men Who Have Sex with Men

MSM account for only 4% of the U.S. male population, bu

they account for about two thirds of reported P&S syphilis 

cases.Although CDC recommends that sexually active

MSM be tested at least yearly for syphilis, many MSM 

are not screened annually.The current situation is stark

reported syphilis among MSM increased 56% from 2011 

to 2015. In 2015, the rate of syphilis in MSM was 106 times

higher than the syphilis rate among men who have sex 

with only women, and half of MSM diagnosed with syphilis 

also have HIV

Addressing syphilis among men is challenging. Syphilis

epidemics vary by geography, race/ethnicity, age, and 

HIV serostatus. Syphilis prevention has historically relied

on partner notification to interrupt disease transmission, 

which has been difficult to scale up to levels that would 

reduce new infections at an MSM population level

Dramatic improvements in access to and effectiveness of 

HIV treatment have resulted in changes in sexual behavior 

and social norms that may reduce the risk of HIV but have 

little impact on syphilis risk reduction, such as treatment as 

prevention, pre-exposure prophylaxis (PrEP), seroadaptive 

behaviors, and reduced reliance on condoms

5
ACTIONS FOR 

SPECIFIC POPULATIONS

Pregnant Women 

Increases in CS have paralleled the national increase in P&S 

syphilis. After a steady decline from 2008 to 2012, cases of CS 

increased by 46% between 2012 and 2015. 

What Pregnant Women Can Do

7 Go to Your Doctor. If you think you may be pregnant, 

see a health care provider as soon as possible to 

be sure that you and your baby are healthy during 

your pregnancy. Prenatal care is important for every

pregnancy. Even if you’ve been pregnant before, it’s

important to ensure that THIS pregnancy is healthy.All

pregnant women should be tested for syphilis, ideally 

at their first doctor visit. Make sure to ask your doctor

about getting tested at your first visit

7 Ask for the Results of Your Syphilis Test. If you test 

positive for syphilis during pregnancy, be sure to get 

treatment right away. Doctors can treat pregnant

women who have syphilis with an injectable form of 

penicillin G

7 Complete Follow-Up Visits with Your Doctor. Continue 

to visit your doctor regularly during your pregnancy 

to be sure that you and your baby stay healthy. If you

learn that one of your sexual partners has or may 

have syphilis, tell your doctor right away so you and 

your partner can be treated, and your baby can be 

protected. If you live in an area where syphilis cases are

occurring among women of reproductive age, retesting 

at the beginning of the third trimester and at delivery 

are recommended. Ask your doctor if you should be

retested during your pregnancy and at delivery

To learn more about CS, visit 

https://www.cdc.gov/std/syphilis/stdfactcongenital-syphilis.h

Gay, Bisexual, and Other Men 

Who Have Sex with Men 

Syphilis rates are increasing among gay, bisexual, and other 

MSM. They comprise 82% of all syphilis cases among men (who 

comprise 90% of all cases of P&S syphilis).

What Gay, Bisexual, and Other Men Who Have Sex 

with Men Can Do

7 Talk to Your Doctor. Have an honest and open talk with 

your health care provider about your sexual history and 

ask to be tested for syphilis and other STDs at anatomic 

sites for exposure.Testing is the only way to be sure

that you do not have syphilis, because many men do 

not have symptoms. If you are HIV negative and have

syphilis, ask your health care provider about PrEP

7 Protect Yourself and Your Partner. If you are sexually 

active, doing the following can lower your chances 

of getting syphilis: (1) being in a long-term, mutually 

monogamous relationship with a partner who has been 

tested and has negative STD test results and (2) using 

latex condoms the right way every time you have sex

If you have sex with more than one partner, don’t use 

condoms, or engage in risky sex behaviors, then you 

should get tested more frequently (e.g. every 3 to

months)

To learn more about syphilis among 

gay, bisexual, and other MSM, visit 

https://www.cdc.gov/std/syphilis/stdfactmsm-syphilis.

6
Health Care Providers

Health care providers can play important roles in reducing CS 

and in reducing syphilis in MSM.

Health Care Providers: Take Action to Reduce 

Congenital Syphilis

7 Complete a Sexual History for Your Patients. Have an 

honest and open talk with your patients about their 

sexual history. STD counseling should be provided to

those at risk for STDs, and contraceptive counseling 

should be provided to those at risk of unintended 

pregnancy

7 Test All Pregnant Women for Syphilis. This should 

occur at the first prenatal visit or at the time pregnancy 

is confirmed. Repeat screening for pregnant women

at high risk and in areas of high prevalence at the 

beginning of the third trimester and at delivery

7 Treat Women Infected with Syphilis Immediately. If 

a woman has syphilis or suspected syphilis, treat her 

immediately with long-acting penicillin G, especially 

if she is pregnant, according to CDC’s STD Treatment 

Guidelines.Test and treat the infected woman’s sex

partner(s) to avoid reinfection. If you have challenges

obtaining penicillin G, contact your state or local 

health department

7 Confirm Syphilis Testing at Delivery. Before discharging 

the mother or infant from the hospital, make sure the 

mother has been tested for syphilis at least once during 

pregnancy or at delivery. If she tests positive, manage

the infant appropriately.All women who deliver a

stillborn infant should be tested for syphilis

7 Quickly Report All Cases of Syphilis and CS. Report 

cases of syphilis by stage to the local or state health 

department right away; CS cases should be reported 

within 24 hours

Health Care Providers: Take Action to Reduce Syphilis 

in Men Who Have Sex with Men

7 Complete a Sexual History for Your Patients. Have an 

honest and open talk with your patients about their 

sexual history. Order CDC-recommended tests based

on age, gender, sex or gender of sex partners, anatomic 

sites of exposure, and risk

7 Test. Perform a syphilis test for sexually active MSM, 

including those with HIV infection, at least annually, and 

as frequently as every 3 to 6 months if there are multiple 

sex partners or substance use

7 Immediately Treat and Report Syphilis Cases. Stage and 

treat syphilis cases according to CDC’s STD Treatment 

Guidelines. Presumptively treat all MSM with signs

or symptoms suggestive of primary or secondary 

syphilis and all MSM who are sexual contacts to a case 

of syphilis at the initial visit. If you have challenges

obtaining penicillin G, contact your state or local health 

department. Report all syphilis cases by stage to your

state or local health department

To find clinician resources related to 

syphilis, visit https://www.cdc.gov/st

syphilis/treatment.ht

7
Public Health Departments

Public health partners work across the spectrum of public health, 

from surveillance, to partner outreach, to working with health 

care providers in order to reduce CS and syphilis in MSM. 

Public Health Departments: Take Action to Reduce 

Congenital Syphilis

7 Partner with Health Care Providers. Offer resources for 

providers on how to properly screen, interpret results, 

and diagnose and treat syphilis.Work with the National

Network of STD Clinical Prevention Training Centers 

(NNPTC) to train and educate providers.Address policy

and other barriers to obtaining early and adequate 

prenatal care for the most vulnerable pregnant women 

in the community.Work together to conduct targeted

screening in various settings

7 Work Together with State and Local STD and Maternal 

and Child Health Programs. CS should be addressed 

through collaboration between these two programs to 

make the most impact. Infant morbidity review boards

could include CS cases to identify missed opportunities 

in the health care and public health systems

7 Conduct Partner Services and Increase Screening.

Prioritize partner services for syphilis cases among 

pregnant women and women of reproductive age, their 

sex partners, and men who have sex with women

7 Partner with Patient Advocacy Groups. Work together 

to engage communities and develop and promote 

programs directed towards their residents

7 Improve CS Surveillance. Work to eliminate data gaps

This could include working with providers and labs to 

obtain pregnancy status along with epidemiologic and 

clinical data on female syphilis cases

Public Health Departments: Take Action to Reduce Syphilis 

in Men Who Have Sex with Men

7 Improve Syphilis Surveillance. Syphilis surveillance 

should capture HIV serostatus, gender of sex partners, 

use of HIV PrEP, ocular and neurological manifestations, 

and sexual and social network characteristics. Syphilis

and HIV surveillance systems and registries should 

be aligned and coordinated. Barriers to data sharing

between STD and HIV programs should be addressed

7 Implement Standing Orders in STD and other Clinics 

Serving MSM. Implement standing orders for a sexual 

health panel of laboratory tests for all MSM seeking 

clinical services

7 Partner with Health Care Providers. Offer resources for 

providers on how to properly screen, interpret results, 

and diagnose and treat syphilis among MSM, including 

those living with HIV.Work with the NNPTCs to train and

educate providers.Address barriers to obtaining care

and work together to conduct targeted screening in 

various settings

7 Work Together with State and Local STD and HIV 

Prevention Programs. Syphilis among MSM should be 

addressed through collaboration between these two 

programs to make the most impact

7 Partner with Patient Advocacy Groups. Work together 

to engage communities and develop and promote 

programs directed towards their residents

8
Decision-makers and 

Community Leaders

Reducing CS and syphilis requires strong public health policy 

and leadership.

Decision-makers and Community Leaders: Take Action 

to Reduce Congenital Syphilis

7 Talk to the STD Program Professionals in Your 

Jurisdiction. Find out what the local syphilis trends 

are and what public health programs are doing to 

address them

7 Address Any Policy Barriers. Support the availability 

of appropriate resources for CS prevention programs

Ensure that policies are supportive of pregnant 

women seeking or obtaining prenatal services and 

recommended screening and treatment for syphilis

Decision-makers and Community Leaders: Take Action 

to Reduce Syphilis in Men Who Have Sex with Men

7 Talk to the STD Program Professionals in Your 

Jurisdiction. Find out about local syphilis trends and 

what public health programs are doing to address them

7 Address Any Policy Barriers. Support the availability of 

appropriate resources for comprehensive screening and 

treatment services for MSM. Ensure that policies do not

prevent MSM from seeking or obtaining recommended 

screening and treatment for syphilis

Biomedical Scientists

Current tools have been used since the 1940s. We need new 

ones to prevent, detect, diagnose, and treat syphilis.

7 Develop new tools for syphilis prevention, detection, 

diagnosis, and treatment

7 Generate interest in the field

Universities and Industry

Research and support are needed to develop new tools and to 

improve existing biomedical tools to reduce all forms of syphilis.

7 Develop and bring to market novel syphilis tests to 

rapidly diagnose active infection (i.e., CS in infants an

all disease stages in adults)

7 Conduct clinical research to improve clinical 

management of all disease stages, including research 

on complications from treatment non-response, repeat 

infection, ocular and neurosyphilis, and HIV co-infection

7 Research effective vaccine design, acceptability, cost, 

and potential impact

7 Stimulate training of biomedical and clinical researchers 

and address basic biological research questions (e.g.

genetics, immune response, pathogenesis) in order to 

galvanize future technological advances in diagnostics, 

therapeutics, and vaccines

Electronic Medical Record (EMR) 

Developers

Current EMRs may not support syphilis screening and treatment 

in patients.

7 Ensure that EMRs support syphilis screening and 

treatment in patients

EMR Vendors

Patient outcomes could be improved by enhancing EMRs. 

7 Support clinical data systems that capture a patient’s 

sexual history, including sexual orientation, gender 

identity, gender of sex partners, and sites of exposure

7 Incorporate accurate, updated STD screening and 

treatment recommendations into EMRs and clinical 

decision support systems

7 Develop data systems that easily interface with 

STD program data and laboratory data to enhance 

surveillance and support a better understanding of 

syphilis transmission and adverse health outcomes

9
New Tools Are Needed for 

Syphilis Prevention and Control

0

NUMBER OF 

VACCINES 

AVAILABLE TO 

PREVENT SYPHILIS

0

NUMBER OF BLOOD

TESTS TO DIAGNOSE

 ACTIVE SYPHILIS 

 INFECTION

 GOAL Create New Tools to Detect 

 and Treat Syphilis

 Syphilis is treatable, but the medicine used to treat the disease

 has been in use for 75 years. Tools to directly detect active syphilis

 in lesions such as commercially available nucleic acid tests or

 complex microscopy are not available for most clinicians. The

 currently available syphilis blood tests cannot detect active infection.

 Clinicians must use the blood test results along with other 

 clinical findings to diagnose syphilis 

 WHAT CAN BE 

 CDC Will

7 Develop and disseminate laboratory guidelines

7 Create and make the syphilis specimen repository 

 available for technological developments in diagnostics, 

 therapeutics and vaccines

7 Evaluate existing and new technologies and incorporate 

 findings into diagnostic guidelines

7 Develop novel diagnostic tools and better molecular 

 surveillance tools, including strain surveillance

GOAL

Improve Electronic Medical Records (EMRs)

Syphilis is a reportable disease that is increasing across 

the country. Keeping records of screenings, diagnoses,

and treatment are vital to managing it and to enhancing 

surveillance efforts. Current EMRs may not include syphilis

screening and treatment or have treatment guidelines 

available for easy access

WHAT CAN 

CDC Will

7 Implement a cloud-based application 

to make STD Treatment Guidelines 

available to all EMR systems

10
There is an urgent need for new tools to prevent, diagnose, treat, and 

manage syphilis. This will allow people to protect themselves from getting 

syphilis or learn quickly and easily if they have it; and help health care 

professionals monitor, and assure effective treatments for years to come.

75

NUMBER OF YEARS 

CURRENT SYPHILIS 

TREATMENTS HAVE 

BEEN IN USE

74,702 

NUMBER OF CASES OF SYPHILIS 

DIAGNOSED IN 2015

E DONE?

Biomedical Scientists Can 

7 Develop new tools for syphilis

prevention, detection, diagnosis, 

and treatment

7 Generate interest in the field

Universities and Industry Can 

7 Develop and bring to market novel syphilis tests to rapidly diagnose active infection in all 

disease stages

7 Conduct clinical research to improve clinical management of all disease stages, including 

complications from treatment non-response, repeat infection, neuro- and ocular syphilis, and 

HIV co-infection

7 Research effective vaccine design, acceptability, cost, and potential impact

7 Stimulate training of biomedical and clinical researchers and address basic biological research 

questions (e.g., genetics, immune response, pathogenesis) in order to galvanize futur

technological advances

AN BE DONE?

Electronic Medical Record 

(EMR) Developers Can

7 Ensure that EMRs support syphilis 

screening and treatment in patients

EMR Vendors Can

7 Support clinical data systems that include a patient’s sexual history, including sexual 

orientation, gender identity, and gender of sex partners

7 Incorporate accurate, updated STD screening and treatment recommendations into 

EMRs and clinical decision support systems

7 Develop data systems that easily interface with STD program and laboratory data to 

enhance surveillance and support a better understanding of syphilis transmission

11
WHAT CDC WILL DO

To reduce the numbers of women and their babies 

who are infected with syphilis, CDC will

7 Work to improve CS data through an enhanced 

CS surveillance system to capture stillbirths, infant 

morbidity, and cases prevented

7 Investigate all CS cases in states to identify missed 

opportunities and improve services

7 Develop tools and evaluate high-impact prevention 

services, such as syphilis screening; timely treatment; 

partner services; and linkage to contraceptive 

counseling, behavioral health, and pregnancy case 

management programs

7 Develop CS prevention guidelines for health care 

providers and health departments

7 Identify and share best practices, such as infant 

morbidity review boards, assessment approaches to 

identify missed opportunities, and implementation of 

system level changes

7 Support health care providers to implement 

recommended syphilis screening and treatment of 

pregnant women and women of reproductive age 

through training, guidelines, tools, and resources

To reverse this increasing trend of syphilis among 

MSM, CDC will

7 Work to harmonize STD/HIV screening 

recommendations and prevention messages related to 

sexual health services for MSM

7 Support health care providers to implement 

recommended STD screening, treatment, and 

vaccination services through training, guidelines, tools, 

and resources

7 Improve syphilis surveillance among gay, bisexual, and 

other MSM

7 Conduct epidemiologic studies to better understand 

factors associated with syphilis adverse outcomes, such as 

neurosyphilis and ocular syphilis, and transmission networks

7 Identify and share best practices

CDC encourages health care providers; 

public health departments; decision makers; 

community leaders; scientists; universities; EMR 

developers and vendors; pregnant women; and 

gay, bisexual, and other MSM to take action.

SOURCES

7 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 201

MMWR Recomm Rep 2015; 64(No. RR-3): 1-137.https://www.cdc.gov/std/tg2015/defaul

7 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015.Atlanta: 

Department of Health and Human Services; 2016.https://www.cdc.gov/std/stats15/default

7 CDC Syphilis & MSM Fact Sheet: https://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.

7 CDC Congenital Syphilis Fact Sheet: https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.

7 CDC November 12, 2015 Dear Colleague Letter from Gail Bolan, Director, Division of STD Prevention: 

https://www.cdc.gov/std/dstdp/dcl-csmmwr-nov-12-2015.

7 National STD Curriculum: http://www.std.uw.e

7 CDC AtlasPlus: Use this interactive, surveillance-based tool to view maps, charts, and tables of syphilis rates 

by age and sex.https://www.cdc.gov/nchhstp/atlas/index

12