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San Francisco Marin Medical Society Blog

California hit hard by resurgence of syphilis. What can be done?

The following blog post was prepared by the organization


In the late 1990s, it appeared possible that the U.S. would eliminate syphilis, a sexually transmitted infection (STI) that affects people of all genders, and can lead to arthritis, blindness, nerve damage, dementia and more if left untreated. Despite efforts by the Centers for Disease Control and Prevention (CDC), the spread of the disease persisted. Within the last 10 years, cases of syphilis have increased sharply, with 115,045 cases reported in 2018.


California has been one of the states hit hardest by the resurgence of syphilis and other STIs. In 2018, there were 25,344 reported cases of syphilis in the state, an increase of 265% from 2008, according to the CDC. Incidence rates are highest in major metropolitan areas like Los Angeles, San Francisco and San Diego, but even less-populated areas have seen a jump in syphilis cases. Marin County, just north of San Francisco, had 38 reported cases of syphilis in 2017, compared to 20 in 2013. In nearby Sonoma County, the number of reported syphilis cases rose from 41 in 2013 to 231 in 2018.


Particularly concerning is the increased number of cases of congenital syphilis, which is syphilis passed from mother to fetus in the uterus. Cases of congenital syphilis in California have been rising for seven years, with an 18.1 percent increase from 2017 to 2018. Congenital syphilis can cause stillbirth, neonatal death, or health complications such as rash, fever, low birth weight, bone deformities, organ damage, and blood abnormalities.

Why have syphilis cases increased?

There are a number of systemic and social reasons behind the rise in cases of syphilis and other STIs.


According to the CDC, budget cuts have negatively impacted clinics and public health programs that test for and treat STIs. Lack of funding has forced clinics to reduce staff and services, or close altogether. In California, the budget for sexual health programs has decreased 40 percent since 2008.


While individuals can seek testing and treatment from private healthcare providers, general practitioners are not as well-trained in spotting and treating STIs as specialized providers. Because of social stigmas surrounding STIs and sexual behavior, individuals may also be less likely to discuss these matters with their primary healthcare provider.


Other social factors, including poverty, unstable housing, and drug use, can lead to increased risk of infection, and prevent people from seeking testing and treatment.


A lack of comprehensive sexual education for young people has also created an environment where individuals do not know how to prevent and recognize STIs.


Additionally, some experts believe that as HIV/AIDs has become more preventable and treatable, condom use has decreased, particularly among gay, bisexual, and other men who have sex with men, leading to easier transmission of other STIs.

Who does syphilis affect?

Gay, bisexual, and men who have sex with men are among the demographics most likely to be affected by this current outbreak of syphilis. This group accounts for 54 percent of all cases of syphilis in the U.S. Black, Hispanic and Native Hawaiian/Other Pacific Islander men experience higher rates of syphilis than other ethnicities.


Diagnosis of syphilis in women also increased 34 percent from 2017 to 2018. This also correlates to the rise in cases of congenital syphilis in newborns. Black and American Indians/Alaska Native women have higher rates of syphilis than other ethnicities.


Other groups at high risk for contracting syphilis, according to California state health officials, include heterosexual homeless individuals, and methamphetimine users.


However, it’s important to remember that syphilis can be spread among all people of all genders, sexual orientations, and socioeconomic statuses, so individuals should always exercise precautions when engaging in sexual intercourse or activities.

What can be done to stop the spread of syphilis?

Practicing safe sex is key to protecting yourself against syphilis infection. Always use condoms when engaging in any type of sexual intercourse, as syphilis can be spread through vaginal, anal, and oral sex. Talk to your partners about their sexual health, and make sure you get tested regularly for syphilis and other STIs.


Testing for syphilis is relatively easy, requiring only a quick blood sample. If caught in the early stages, syphilis can be treated and cured easily with antibiotics. The symptoms of primary and secondary stage syphilis are not always obvious, so it’s important to get tested regularly, because you may not know if you’ve had sex with an infected person, or become infected yourself.


There are a variety of different ways to get tested for syphilis and other STIs, including through your general physician or gynecologist, or clinics like Planned Parenthood. In Marin County, Marin Community Clinics offer STI testing, as well as services for teens through community partners. 


Systemically, the spread of syphilis can be stopped with better resources and education to destigmatize STIs, and keep people better informed about their prevention, transmission, and treatment. California’s Board of Education recently revamped its sex education curriculum to be more inclusive and comprehensive. Time will tell if these efforts help protect individuals and stop the spread of STIs.

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