AN OLD FRIEND IS BACK

A sexually transmitted disease the world thought it eradicated is coming back at an alarming rate

In recent months, newspapers around the country have published stories that sound like they could have been written 100 years ago. Indiana’s syphilis cases skyrocketed by 70 percent in a single year. Texas’ Lubbock county was under a “syphilis alert.” Various counties faceshortages of the medication used to treat syphilitic pregnant women.

But the headlines are very much modern—and urgent. Syphilis is back, public-health experts say.

For many years, syphilis was considered a practically ancient ailment—a “Great Pox” that, like tuberculosis or polio, Americans just don’t get anymore. There were just6,000 cases of primary and secondary syphilis in 2000, and the CDCbriefly thought the disease’s total elimination was within reach.

But in November, the CDC reported that there were nearly 20,000 cases in 2014. While the rates  haven’t climbed close to the devastating levels of the early 1990s, they’re rising at an alarming rate. Perhaps most concerning, the past two years have seen a cluster of cases of syphilis of the eye, and a rise in cases of congenital syphilis—something even developing countries have been able to eliminate .

This year, the U.S. Preventive Services Task Force recommended screening high-risk people for syphilis every three months. The disease is curable with antibiotics, but it’s a bit of a secret agent, transmissible through almost every sexual means and erupting as a tiny lesion about a month after exposure. At various stages of the infection, it might cause no symptoms or a puzzling array of them. If gone undiagnosed, it can cause everything from disfigurement to seizures.

As a result, “many people don’t know what syphilis is or how it’s transmitted,” said Darryl Richards, the STD coordinator in Decatur, Georgia, which has one of the highest syphilis rates in the country. “Most people associate sexually transmitted infections with a discharge or a burning sensation. However, syphilis does not cause these symptoms.”

Among gay men, the syphilis infection rate has increased to levels not seen since the start of the AIDS epidemic of the 1980s. Some public-health experts we interviewed think the syphilis resurgence might be driven, in part, by the rise of hook-up apps such as Grindr. And with the AIDS crisis now a distant memory, gay men might not be as careful with condoms as they once were. Indeed, those factors help explain why syphilis rates have also spiked in parts of Canada andEurope.

But others say a big reason is federal and state governments’ failure to adequately fund local public-health budgets.

“This is a sentinel event—it is a failure of the healthcare system,” Gail Bolan, the CDC’s director of STD prevention, said at a recent Congressional briefing.

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