One Year of Action: HHS’s Efforts to Flatten the Curve of the Syphilis Surge

In the year since the U.S. Department of Health and Human Services (HHS) established the National Syphilis and Congenital Syphilis Syndemic Federal Task Force in September 2023, the cross-agency effort is working to reduce the cases of syphilis and congenital syphilis through a variety of efforts. The Task Force includes participants from HHS agencies and offices, including the Indian Health Service (IHS), Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), and Substance Abuse and Mental Health Services Administration (SAMHSA), as well as the Department of Agriculture, Department of Justice, Department of Veterans Affairs, and the White House’s Office of National Drug Control Policy and Office of National AIDS Policy.

The efforts of the Task Force include expanding access to syphilis testing and treatment, enhancing data collection and heightening surveillance, increasing awareness and education among provider groups, and engaging communities and health departments. The Task Force, and all of HHS, continue to mobilize federal resources, foster health equity, and engage with the communities most affected by this public health crisis.

Expanding Access to Syphilis Testing and Treatment

• CDC published clinical guidelines to assist healthcare providers in counseling patients regarding doxycycline post-exposure prophylaxis (or doxy PEP) for bacterial sexually transmitted infection (STI) prevention, including syphilis. Doxy PEP has proven to reduce the risk of getting a bacterial STI for gay, bisexual, and other men who have sex with men and transgender women at increased risk for bacterial STIs.
• FDA exercised enforcement discretion for a temporary importation and use of Extencilline® and Lentocilin to mitigate the effects of a shortage of the syphilis treatment drug Bicillin L-A®.
• HHS issued Considerations for the Implementation of Point of Care Tests for Syphilis, a resource that outlines four main differences between syphilis point of care tests and laboratory-based serologic syphilis tests and highlights the best settings to consider the use of point of care tests. It also examines parameters for point of care testing program implementation and management, provides answers to common questions, and lists links to related resources.
• The Task Force leveraged funding flexibilities for grant programs from multiple different agencies (CDC, HHS Office of Population Affairs, HRSA, and SAMHSA) to enhance the use of grant funds—including staff time—for counseling, testing, and treatment services for those affected by syphilis and congenital syphilis.

Enhancing Data and Heightening Surveillance

• HHS generated heatmaps for priority jurisdictions, overlaying primary and secondary syphilis and congenital syphilis cases with HHS resources, including Title X family planning clinics, Ryan White clinics, IHS clinics, and Federally Qualified Health Centers.

Increasing Awareness and Education Among Provider Groups

• To commemorate STI Awareness Week, several Task Force members hosted webinars to share knowledge and tools to help reverse the syphilis and congenital syphilis epidemic, including the Office of Infectious Disease and HIV/AIDS Policy’s “At a Crossroads: The Syndemic of Syphilis, Substance Use, and Child Welfare During Pregnancy,” CDC’s "Syphilis in the US: The current state of the epidemic and how it’s being addressed,” and HRSA’s “Tackling STIs and Syphilis Prevention with Doxy PEP.”
• The Task Force also hosted Stopping Syphilis: The HHS Summer Seminar Series, a webinar series highlighting the latest developments and best practices, and tools for syphilis management.
• HHS hosted an in-person roundtable with provider groups who care for pregnant patients in a variety of settings to identify ways to reduce congenital syphilis.

Engaging Communities and Health Departments

• HHS hosted various workshops and engagements to gather community input on how best to improve syphilis and congenital syphilis outcomes, including two workshops—one with American Indian and Alaska Native tribes and the other with providers who represent populations disproportionately affected by syphilis and congenital syphilis, about how to better support community efforts to improve health equity and support related syndemic, sexual, and reproductive health services. HHS also held a Tribal Consultation on Syphilis and Congenital Syphilis to seek information from Indian country about possible HHS actions that may support Tribal efforts to reduce the number of syphilis and congenital syphilis cases among American Indian and Alaska Native populations.
• IHS issued a letter to Tribal leaders and Urban Indian organizations, with recommended guidelines for syphilis testing, treatment, and prevention, and shared an update on efforts by IHS to address the syphilis epidemic in Indian country.
• HRSA and CDC issued a letter to all HRSA-supported health centers on congenital syphilis and resources and recommendations for addressing the increase in cases, stressing the importance of obtaining a comprehensive sexual history, early screening of pregnant individuals, early testing, and early treatment.
• The Office of the Assistant Secretary of Health (OASH) Regional Offices convened regional meetings with all jurisdictions and additional regional partners such as community health worker organizations, tribal organizations, academic institutions and others to ensure communication and amplified resources across all jurisdictions.

While HHS acknowledges the achievements over the past year, syphilis remains an urgent issue, and the effort continues to quickly and strategically reduce rates of primary and secondary syphilis and congenital syphilis in our country. The Task Force will continue to collaborate and raise awareness about this critical public health challenge.