Syphilis is an infection that has killed millions over the span of centuries and affected key figures like Al Capone and Edouard Manet. When the life-changing development of antibiotics arrived, it brought the disease under control, and, for years, syphilis outcomes improved. However, syphilis is on the rise again across the world. In 2025 alone, more than 20 babies in Hungary have died of congenital syphilis, which means they contracted the disease from their mothers. The advancement of syphilis is occurring not just abroad, but domestically, as well. In Mississippi, there has been an 80% increase in recent cases and a 1000% increase in congenital syphilis in the last six years. The global danger of the resurgence of the disease represents a medical danger and a failure to uphold the right to health. As syphilis is a preventable and treatable disease, these rising cases globally expose inequities in healthcare access, surveillance, and social determinants of health.
What is Syphilis?
Syphilis is caused by Treponema pallidum bacteria and is a sexually transmitted infection. Women can also pass the disease to their babies during pregnancy; this is considered congenital syphilis. The development of the infection is broken up into four different stages: primary, secondary, latent, and tertiary.
Each stage is categorized by different outcomes and demonstrates the development of the disease. The primary stage is categorized by the appearance of a sore; though it is a minor sight, testing and treatment is still critical at this stage to ensure that the infection does not transition into the secondary stage. This next stage is categorized by the appearance of rashes and symptoms like swollen lymph glands and a fever. Treatment is critical at this stage as it addresses key symptoms and prevents the development of latent and tertiary stages. Latent stage represents a short period in which there are no signs or symptoms; this tends to induce no urgency for treatment, which in turn can result in further disease transmission and congenital syphilis. The tertiary stage, which is the final stage, includes significant damage to organ systems and can result in death. There is also the risk of development of neurosyphilis, which is when the disease spreads into the nervous system, ocular syphilis, which is when syphilis spreads to the eye, and otosyphilis, which is when the bacteria spreads to the ear. This type of spread can occur at any stage and compounds the debilitating nature of the illness.
When syphilis remains unchecked, it violates the right to health.
Treatments and Prevention
Key interventions for syphilis include medical tests, for example a treponemal test, which is a blood test that is often given after certain physical symptoms appear and which indicates whether the patient has ever had syphilis. Latent infections require serologic testing, which identifies antibodies in a patient’s blood to identify that there is either a current infection or that there has been a previous infection. Gathering this information is critical, considering this stage of syphilis is categorized by no symptoms or signs. Upon testing and confirmation of the presence of syphilis, usually penicillin is administered; this intervention is quite successful but poses a risk for individuals who are allergic to penicillin and those who have limited access to healthcare providers who can not only administer the medicine but also educate the patient about the appropriate treatment regime.
Syphilis prevention consists of general safe sex tips, such as condom usage, consistent testing, and communication with sexual partners. These practices, however, are restricted by disparities observed across the globe. For example, data suggests that there is a negative association between a region’s Social Demographic Index and unsafe sex; this contributes to the risk of sexually transmitted infections, including syphilis, that rise as a region’s Social Demographic Index (an indicator that is composed of “total fertility, per capita income, and average years of education“) falls.
Public Domain
The Global Surge of Syphilis
Global disparities have enabled a surge of syphilis. From 2020 to 2022, the number of new adult syphilis cases across the globe increased from 7.1 million to 8.0 million; this correlates to a global prevalence of active syphilis of 0.6% in 2022. The burden is also observed in congenital cases. In 2022, the congenital case rate was 523 per 100,000 live births, representing over 390,000 adverse birth outcomes including stillbirths, low-birth weights, and neonatal deaths.
Beyond the global statistics that demonstrate the general outcomes of the disease, it is critical to understand the burden of the infection through a regional lens. In 2020, Africa, the Americas, and the Western Pacific were burdened significantly more than their global peers, with incidence rates of 96 million, 74 million, and 86 million, respectively. These areas have limited access to adequate screening opportunities, which not only impacts adult populations but also allows for congenital syphilis to remain rampant. Additional factors, such as stigma, contribute to barriers, especially for men who have sex with men, which allows for the further development of the disease.
The development of the disease burden reflects structural and social failures that leave vulnerable communities unable to support themselves and their health. For example, key populations affected by syphilis include gay men and men who have sex with men; these populations are already underrepresented and underserved.
The Future of Change
Despite these challenges, significant progress has been made to support the development of key systems and procedures in the fight against syphilis. This was a key goal of the World Health Organization in 2025, and the organization hopes to end sexually transmitted disease epidemics within the next five years.
To accomplish this goal, the World Health Organization worked with countries to develop plans for how to address sexually transmitted diseases, provided case management guidelines, recommended dual HIV and syphilis rapid diagnostic tests, and more. Specific recommendations were made regarding syphilis through testing and partner services. Generally, the adoption of key policies to fight sexually transmitted diseases has been observed in Africa, the Americas, and the Western Pacific, which is encouraging in terms of improving access to the right to health. Some delays in introduction of these approaches have been seen in some countries due to geopolitical instability, but general trends suggest uptake of recommendations and progress towards the 2030 goal. In order to ensure that this goal is achievable, key resources need to be mobilized and made accessible to ensure progress does not stall.
Conclusion
Although progress has been made in terms of syphilis prevention and treatment, additional approaches are critical to ending the crisis. In tandem with support from multilateral collaboration, it is critical to strengthen public health access. From mobilizing additional resources to providing accessible screening, vulnerable communities can gain access to resources that would allow them to take ownership of their health outcomes. This would be accompanied by educational efforts to help destigmatize sex education and reduce disease transmission. Alongside these interventions, surveillance and data collection is critical, because this will not only document changed outcomes, but it will also help identify opportunities for collaborations, making health systems more resilient.
Because syphilis is a treatable and preventable infection, it is clear that this global resurgence of the disease is not inevitable; rather, it is an outcome of inequity, stigma, and broken systems. When working to preserve the right to health, people need to be protected both right now and for generations to come.
