Syphilis rates in the United States have climbed nearly 80% since 2018—an epidemic revealing deep racial, regional, and behavioral health divides. Recent research using CDC surveillance data exposes especially severe disparities, with American Indian/Alaska Native individuals facing odds nearly eighteen times higher than white peers in 2022. Black Americans follow, with seven times the risk. These increases hit hardest in the Midwest and rural Southern states, notably South Dakota, where the majority of cases involve Indigenous people.
Social and systemic barriers play a crucial role. Historical poverty, limited healthcare access, and systemic racism fuel persistent inequities driving infection rates. Healthcare shortages and transportation hurdles restrict timely STI testing and treatment in underserved areas, and researchers recommend stronger partnerships with Indigenous-led organizations, mobile clinics, and telemedicine to reach high-burden communities. Community-centered campaigns, similar to successes in HIV care, could sharply improve prevention and trust.
High-risk behaviors also escalate syphilis spread. Sex with anonymous partners carries over thirteen times the infection odds versus transactional sex, while methamphetamine use increases risk threefold. Men who have sex with men remain the most affected group, but the near doubling of cases among women is a worrying new development—likely tied to under-testing and access gaps—raising rates of congenital syphilis nationwide.
Researchers urge targeting STI screening and care in rural, minority-heavy regions, and integrating syphilis response with substance abuse treatment and behavioral health programs. Culturally tailored outreach and stable medication access can narrow these gaps.
