Syphilis Cases in Michigan Are Surging. Here’s Why.

Jake Newby

| 5 min read

In the 1990s, syphilis cases were so low in the United States that the disease seemed to be on the brink of eradication. But multiple factors have led to a resurgence in cases.
Syphilis cases have doubled in Michigan between 2017 and 2022, according to the Michigan Department of Health and Human Services (MDHSS). This pattern reflects national trends, as 207,255 cases of syphilis were reported in the U.S. in 2022. That’s the highest number since 1950, according to the U.S. Centers for Disease Control and Prevention (CDC).
As medical experts, we believe cases started spiking seven years ago because of a change in the epidemiology of the infection. Syphilis used to predominantly circulate in communities of gay and bisexual men, but this recent surge has a high concentration of cases in both heterosexual men and women.
Syphilis is a highly contagious sexually transmitted infection (STI), most often spread through unprotected sex. Syphilis can also be transmitted congenitally, when a mother with the disease passes the infection on to her baby during pregnancy. Congenital syphilis has been a major cause for concern during the disease’s recent bounce-back, as over 10 times as many babies were born with syphilis in 2022 than in 2012, per the CDC.

What are the four stages of syphilis?

The first, or primary, stage of syphilis is characterized by sores around the mouth or genital region, left by syphilis’ entrance into the body. These sores – which are typically painless – usually heal within three to six weeks, whether a person receives treatment or not.
The secondary stage occurs in those who do not receive treatment. The infection evolves into skin rashes, typically on the palms of your hands and bottoms of your feet, and mucous membrane lesions. Per the CDC, this stage can result in:
  • A sore throat
  • Fatigue
  • Fevers
  • Headaches
  • Muscle aches
  • Patchy hair loss
  • Swollen lymph nodes
  • Weight loss
The third, or latent, stage is marked by showing no physical signs or symptoms of syphilis, but still being able to transmit it. This stage can last for years, according to the CDC.
Most people do not develop the fourth, or tertiary stage of syphilis. For those that do, this is a serious condition that can affect many systems in the body and can occur many years after the infection began.
At any infection stage, syphilis can affect the nervous system, visual system and auditory system and result in changes in mental status, blindness and potentially permanent hearing loss.

Why are cases increasing in Michigan?

Nationally, the increase in syphilis cases can be blamed on multiple factors, including:
  1. A shortage of a type of antibiotic that treats syphilis. The epidemiology of infections also has changed, they say.
  2. Insufficient prenatal health care (specifically in the case of more babies being born with syphilis infection).
  3. Less testing and education than in the past.
  4. Public health dollars shifted away from sexually transmitted infections testing to COVID-19 during the pandemic.
According to the MDHSS, the number of primary and secondary cases among Michigan residents who report only heterosexual sex has more than doubled since 2013, increasing from 19% to 48% in 2022.
In 2022, 972 Michigan residents were diagnosed with either primary or secondary cases of syphilis, 313 of which lived in Detroit.
As more women contract the infection, more babies are contracting it congenitally. The MDHSS states that Michigan experienced 37 cases of congenital syphilis in 2022, with numbers trending up for more than 10 years; in 2009, only four cases were reported.
Men are most often diagnosed with syphilis in Michigan, accounting for 79% of cases. But black men have 10.2 times higher rate of diagnosis than white men, according to the MDHSS, while gay and bisexual men still make up the highest percentage of Michigan’s primary and secondary syphilis cases at 39%.

Testing and treatment options for syphilis

The state health department is working with emergency departments to try and increase syphilis testing, according to the Detroit News.
Most syphilis cases are relatively easy to treat, but not all affected communities have access to health care, particularly prenatal care. The racial and ethnic disparities in syphilis cases can’t be understated, which requires a greater need for outreach and education for health care providers about the importance of syphilis testing and treatment. Here is a list of STI clinics in the state, most of which test and treat syphilis. If they do not, it is otherwise noted.
If caught in time, syphilis is treatable and curable Penicillin is still the most effective antibiotic for treating syphilis. However, challenges can arise even after an infection is diagnosed. In April 2023, the Food and Drug Administration (FDA) reported a shortage in bicillin, also known as penicillin G. Then in January 2024, the FDA approved the temporary importation of Extencilline, a bicillin equivalent distributed in other countries, to help offset the shortage.
Be sure to speak with your primary care provider (PCP) to discuss available treatment options, as well as which options are best for you based on your health profile.
James D. Grant, M.D., is senior vice president and chief medical officer at Blue Cross Blue Shield of Michigan
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MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association