The Crisis of Syphilis in America: A Blog from NCSD's Bill Smith Coinciding with CDC Syphilis Summit

Recent data from the Centers for Disease Control and Prevention (CDC) show that for the first time in a decade, the three most common STDs reported to health departments – chlamydia, gonorrhea, and syphilis – are all up.  Of critical concern is syphilis.  For the third year in a row, reported cases of primary and secondary syphilis – the stages where the infection is most likely to spread – have increased by double digits.  In 2012, syphilis increased by 11 percent, in 2013, by 10 percent, and in 2014, by a shocking 15 percent.

There was not a single demographic that escaped these increases.  Males and females, LGBT persons and heterosexuals, and even babies experienced increases in syphilis.  In fact, between 2012 and 2014, congenital syphilis, which can be a disabling, and often life-threatening infection, increased by 38 percent, to the highest rate in almost 15 years.  Increases have also occurred in cases of syphilis that are resulting in significant eyesight and vision problems, including instances of complete and irreversible blindness.

Just over a decade ago, syphilis elimination in this country was deemed within sight.  In 1999, the CDC launched the Syphilis Elimination Effort, designed to bring health care providers, policymakers, and community leaders together with state and local public health agencies, to reduce syphilis rates.  So how did we get from there to here?

For starters, since 2003, federal investments in STD prevention have been stagnant.  In fact, due to mostly flat funding, the real buying power of those dollars has plummeted 36 percent.  So while the CDC saw a public health imperative to move toward syphilis elimination, there were no new dollars.  State, territorial and local health departments across the country charged with syphilis elimination valiantly moved forward, but the weight of the work was overburdened by a lack of national investment in these efforts and in public health. 

According to Trust for America’s Health, combined federal, state and local public health spending is currently below pre-recession levels.  Adjusting for inflation, public health spending is currently 10 percent lower in 2013 than in 2009.  At the same time, state and local investments, largely as a result of the recession budget crunch, have equally collapsed.  At the height of the recession, the National Association of County and City Health Officials reports that up to 45 percent of local health departments reported budget cuts; one in four is still affected by budget cuts today.  Since 2008, 51,700 jobs have been lost at local health departments.  

The nonsensical utterance:  “Do more with less” has reached a breaking point.  We are not doing more with less – we are doing less with less.  As a result, when it comes to STDs, we are in the midst of true genuine crisis.

Adding insult to injury, during the 2015 Congressional session, the United States Senate Appropriations Committee proposed a $32 million dollar cut to the already anemic federal investment in public health STD programs.  This proposed cut—coming at a time of unprecedented STD increases—was to an already very small federal budget line.  Total federal investment in state and local health departments to safeguard the public’s health when it comes to STDs is $157.3 million – as much as the Department of Defense spends in an estimated three hours.

This week, the CDC’s Division of STD Prevention is holding a critical discussion on this issue billed as the “Syphilis Summit.”  Coming none too soon, we applaud the CDC for its leadership in seeking solutions to the crisis.  To assist state, territorial and local health departments with the crisis, we need big thinking and smart people behind the effort.

What we truly need more than anything, however, are policymakers at every level to recognize that we have a major problem on our hands regarding STDs and that we need increased governmental support to deal with it.  The evolving health care delivery system cannot – and is not – able to deal with the scale of this crisis.  They can be part of the solution, but public health must lead when it comes to STDs when they reach these epidemic levels.

The CDC’s Syphilis Summit will no doubt yield important and strategic efforts to invest in securing the sexual health of Americans, but without the resources needed from policymakers, they will remain words on a page, crying out for someone to read them and pay attention.  We have already had one Syphilis Elimination Effort ripped from our grasp, and it is here, at this moment of crisis, where we find ourselves. Again.

William A. Smith is the Executive Director of the National Coalition of STD Directors in Washington, D.C.