Syphilis rates are on the rise: but why?

What was once considered to be close to being eradicated, syphilis rates have been steadily climbing over the past 20 years. According to the Centers for Disease Control and Prevention (CDC) in 2019, there were nearly 130,000 cases of syphilis nationwide. In a study conducted by, North Carolina ranks among the worst states when it comes to sexually transmitted diseases.

Rises in cases can be contributed to drug use, dating apps, and even HIV medications. One of the reasons for the rise in syphilis cases is the use of methamphetamines. Risky sex behaviors that often accompany such drug use increase the chances of acquiring and transmitting sexually transmitted diseases (STDs). Such behaviors include multiple sex partners, lack of consistent condom use, as well as exchanging sex for drugs or money.

Dating apps like Tinder have also made it harder to track the spread of STDs and notify people who may have been infected. Often, users don’t use their real name and if the date doesn’t go well, they block the person and then if one is infected, there’s no way to notify the other person.

Medications that prevent the transmission of HIV including antiretrovirals that suppress the virus in those who are HIV-positive; and preexposure prophylaxis, or PrEP, which prevents new infections in people who are HIV-negative, but considered at-risk for exposure to the virus have had an unintended consequence: condom use has fallen by the wayside. While these medications can suppress and prevent HIV, not using condoms increases the spread of other STDs.

Syphilis statistics for North Carolina:

  • The number of early syphilis cases diagnosed in North Carolina in 2019 was 2,117, a rate of 20.2 per 100,000 population. This is a slight increase from previous years (2017: 1,911 cases and rate of 18.6 per 100,000; 2018: 1,910 cases and rate of 18.4 per 100,000).
  • There were 27 infants reported with congenital syphilis in 2019. This number is an important increase from the 19 probable congenital syphilis cases reported in 2018.
  • Early syphilis cases increased among women in 2019. There were 352 early syphilis cases (6.5 per 100,000) in 2019, compared to 309 cases in 2018 (5.8 per 100,000). 
  • The highest rates of newly diagnosed early syphilis occurred in 20- to 24-year-olds (rate of 51.6 per 100,000) and 25- to 29-year-olds (66.4 per 100,000). Cases in these age groups comprised 40.0% of the total early syphilis cases in 2019. 
  • Black/African American men had the highest rates of early syphilis (98.8 per 100,000) and accounted for 50.6% of total early syphilis cases in 2019. 
  • Men who report sex with men accounted for 55% of newly diagnosed early syphilis in North Carolina in 2019.

Syphilis starts as a painless sore, typically on the genitals, rectum, or mouth. It is transmitted from person to person via skin or mucous membrane contact with these sores. If caught early, syphilis can be cured, sometimes with a single shot of penicillin. However, without treatment, syphilis can severely damage the heart, brain, or other organs and can be life-threatening. It can also be passed from mothers to their unborn children.

Left undetected and untreated, it can develop into flu-like symptoms and a rash all over the body, including the palms and soles of the feet. Untreated babies with syphilis can go blind, be developmentally delayed, or even die.

For babies, it’s important to start the 10-day antibiotic treatment right away to avoid complications.It’s important to follow these infected babies through their first year of life, and often through their childhood, to watch for vision and hearing problems, developmental delays, attention deficits and learning disabilities, all of which can result from congenital syphilis infections. In 2019 congenital syphilis cases increased 279% over the previous five years and hit an all-time high of cases in the U.S. That is more mother-to-child transmission of syphilis than there was at the peak of mother-to-child cases of HIV in 1991.

Sadly, many of the women who give birth to babies with syphilis have had no prenatal care. And they are often meth users and homeless. This makes them more likely to trade sex for housing, food or drugs. Drug use, in particular, makes women less likely to recognize that they’re pregnant at all and less likely to seek health care if they do.

Thankfully, there are resources dedicated to testing for STDs including the Pender County Health Department. Patients seeking STD services at the health department have complete personal privacy, and will receive a complete evaluation, along with appropriate diagnostic and treatment care. Preventive education on STDs is also available by appropriately trained staff.

Pender County Health Department

803 S. Walker Street
Burgaw, NC 28425

STD Clinic Hours

Monday – Friday

8:00 a.m. – 11:00 a.m. and 1:00 – 4:00 p.m.

Walk-in or By Appointment

Sources: NPR, CDC, Forbes, and NCDHS.