1057: STI Trends: Progress, Prevention, and the Urgent Rise in Congenital Syphilis

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, January, 26 2026. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Today, we discuss new CDC surveillance data that shows encouraging declines in several sexually transmitted infections, though a troubling increase in syphilis among newborns, as we continue our Legislative Prospectus Series examining the public health policy trends set to shape 2026. Our guest is the Director of the Division of STD Prevention at the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Dr Bradley Stoner.

Dr Bradley Stoner, welcome to the show.

BRADLEY STONER: 

Thank you very much. Glad to be here.

SHEEHAN: 

Dr, Stoner, what are the big takeaways from the 2024 STI Surveillance Data?

STONER: 

Well, the report shows that last year in 2024 syphilis and newborns increased for the 12th year in a row in the United States, with nearly 4,000 cases of newborn syphilis reported to the CDC. Now this was a 2% increase relative to the previous year, compared to double-digit increases in some recent years, so there is evidence of a slowing of this increase, but still, 2024 cases were nearly 700% higher than 10 years ago. So there's a long way to go to address this deadly but preventable consequence of the ongoing syphilis epidemic. Now, the report also shows that overall, the STI burden remains substantial in the United States, but there are signs of progress that hopefully will continue. The latest data show that more than 2.2 million STIs were reported in 2024, and this is a 9% decline from 2023. Moreover, primary and secondary syphilis cases, which are the most infectious stages of syphilis, declined by nearly 22%, and this is the second year in a row of primary and secondary syphilis declines. Chlamydia cases declined by 8%, also for a second year in a row, and gonorrhea cases declined by nearly 10%, and this is the third year in a row we've seen gonorrhea declines. So there is room for optimism, but we cannot take our eye off the goal, which is slowing and reversing the STI epidemic completely.

SHEEHAN: 

Yeah, that sounds there's a, there's a mixed bag there. How do you, how do you parse this?

STONER: 

Well, we clearly think that the national declines are tangible evidence of the important impact of public health efforts. I consider this the prevention impact, the value of prevention, and the efforts that we're doing at the CDC and national level to provide leadership for state and local health departments, which are doing the work on the ground. This includes, first of all, work to increase awareness of the STI epidemic at the state and local level. So publicizing STIs as a public health problem and creating prioritization of the need for STI prevention and helping state and local health departments prioritize STIs through awareness, we also are working to expand public health efforts to control STIs, which includes increased partner outreach and notification efforts, increased awareness of clinical service availability and expanded use of what we call expedited partner therapy, which is the provision of treatment to patients, to provide to their partners without the need for a clinical exam for those partners. So all of these things are tools that we have to promote STI prevention. And finally, I would point out that we're expanding efforts to increase uptake of prevention, innovations like self-tests for STIs and increased use of Doxy PEP, which is the provision of doxycycline as post-exposure prophylaxis to patients with an STI to reinfection. So all of these are really excellent approaches to STIs, but we really have to accelerate our progress to stop the STI epidemic. So although we're encouraged by the the data in the in the report, in some cases, we really our goal is to is to capitalize on these results and to ensure that the STI epidemic comes under control.

SHEEHAN: 

Yeah, as you say, evidence is slowing, but rates are still going up.

STONER: 

Yes, and I don't want to lose track of the 4,000, nearly 4000 cases, of congenital syphilis, because this is a major problem for us, and something that we can do something about.

SHEEHAN: 

Is there context within demographic breakdowns? I mean, how else should we think about this?

STONER: 

Well, it's important to remember that the 2024 surveillance report is provisional, which means that the data have not been finalized, and so we just don't have the data to say where in the country, population level-specific differences are occurring. We know that considering the surveillance data specifically, there are the nearly 4,000 cases of newborn syphilis, which I talked about previously, which were reported to CDC in 2024 and that beyond the surveillance data, we know that CDC, that CDC estimates, one in five people in the United States has an STI and so the STIs affect the health of millions of Americans. And while the STI epidemic touches nearly. Every community, some geographic areas, and populations may experience increases or decreases not reflected by the newest 2024 national data. So we just can't make those determinations yet. What's happening is that CDC is migrating its National Notifiable Diseases Surveillance System, or NNDSS, data and its processing to a new platform called One CDC Data Platform, or 1CDP. And because of this, CDC has postponed reconciliation and publication of 2024 case surveillance data to allow state, and local health departments, and CDC more time to onboard the 1CDP. So the final numbers may change for 2024 but the overall trends are there, and we just can't make population level, specific analyzes at this time, we just don't have those data, but we feel it's important to release STI data in a timely way so that the 2024 provisional report is essential, because CDC, and local and state STI programs rely on these data to inform their ongoing STI prevention efforts.

SHEEHAN: 

Sure, absolutely. So, with that in mind, how should local agencies start thinking about how they should use these results to sort of drive their interventions? It sounds like working towards lowering infant syphilis is a big one.

STONER: 

Lowering infant syphilis is a big one, and we feel that the importance of having and sharing updated data at the local level for communities is critical, and CDC is committed to making this easier. For example, health departments can access county-level syphilis data from our website to identify counties with high rates of syphilis, and these data can then be used to help notify physicians in these counties to encourage more testing and coordinated treatment. So this is important, not just for overall syphilis, but for maternal syphilis, so identifying pregnant women with syphilis and providing treatment to prevent syphilis and newborns. Now, I would say, John, that while the data indicate we may be turning the corner in some respects, we must accelerate the progress to stop the STI epidemic and its most tragic consequences. We have excellent resources at CDC, such as our updated program guidance for STI programs. We call these the program operation considerations for STI prevention, and also an updated outbreak toolkit known as the STI outbreak preparedness and response toolkit. These are valuable resources to assist state, tribal, local, and territorial health departments in preparing for and responding to sexually transmitted infection outbreaks.

SHEEHAN: 

And what can states sort of take away from the results in terms of, again, either prioritizations or just sort of lessons learned from what's been working, what hasn't been working?

STONER: 

Well, CDC is empowering states and communities to prioritize STI control so that we can address the epidemic at federal, state, and local levels. There are several areas that can be prioritized to strengthen response to STI efforts and jurisdictions, including, for example, enhanced screening and treatment of pregnant women for syphilis, and identifying maternal syphilis cases, and providing treatment before the cases advance. This is probably one of the most important ways that we can work with state and local partners to prevent congenital syphilis. We're also very excited about expanded use of doxy PEP or doxycycline as post-exposure prophylaxis in STI clinics and HIV care and prevention clinics, and this will help prevent recurrence of chlamydia as well as syphilis in persons who are diagnosed with these infections. I want to point out that we are paying very close attention to antimicrobial resistance in gonorrhea. So, heightened awareness and response to antimicrobial resistance for gonorrhea, if and when it does occur in the U.S., is part of the CDC focus. We have a whole program, which we call cargoes combating antimicrobial resistant gonorrhea, and other STIs, which tracks gonorrhea resistance nationally, so we're paying very close attention to that. CDC is promoting expanded use of new testing technologies, such as self tests for syphilis that can identify new cases in non-clinical settings, and state and territorial health departments can provide avenues for community based organizations and other groups to access point of care tests for syphilis, and one test is now over the counter, as well as point of care tests for gonorrhea and chlamydia. And finally, I would say, reaching people more effectively by offering STI testing and treatment in more settings where people access care and services.

SHEEHAN: 

Dr. Stoner, I'm wondering, you mentioned the CDC is migrating its data to a new platform. Do you have a sense of the roadmap to completion and what the new platform can offer public health officials?

STONER: 

Well, the new platform is called One CDC Data Platform, and my understanding is that the migration to this new platform will occur in 2026. When that happens, we will be able to finalize 2024 and 2025 surveillance data. There's a bit of a delay, but it will also allow greater access to data across a variety of reportable conditions. So the expectation is that the new platform will be more nimble and more accessible to partners. So while this allows us, at this point, we're required to issue provisional data on STIs, we'll have a final STI Surveillance Report for 2024 and 2025 available in the coming year.

SHEEHAN: 

Yeah, more robust look, even though right now, data is somewhat rough at best.

STONER: 

I think we don't think that the overall trends will change, but the, some of the specifics may. We have enough data to know that the overall case burden will remain about the same, but some of the specifics at the local level may change in terms of case numbers.

SHEEHAN: 

Dr. Bradley Stoner is the director of the Division of STD Prevention at the National Center for HIV, Viral Hepatitis, STD, and TB Prevention. He joined us as part of our Legislative Prospectus Series, examining the policy trends set to shape public health in 2026.

Access to contraception is changing, and pharmacies are at the center of it, with the FDA approval of the first over-the-counter birth control pill, more people can now get contraception without a doctor's visit, especially those who are uninsured, live in rural areas, or previously relied on less effective methods. Early research shows OTC access is already closing gaps in care by making contraception more convenient and flexible. But this promise comes at a time when pharmacies themselves are under strain, face enclosures, workforce shortages, and even insurance coverage that can drive up out-of-pocket costs. Public health agencies have a critical role to play, improving reimbursement, supporting pharmacy capacity, expanding retail and alternative distribution models, and educating both consumers and providers. Learn more at the link in the show notes.

ASTHO's "Organizational Strategic Planning Guide" provides health agencies with an overview of the organizational strategic planning process, comprised of seven major phases that an organization should complete on a recurring basis to adapt and refine their plans over time. This allows organizations to remain responsible as their needs and goals evolve. In addition, the guide reviews keys to success and highlights tips for addressing common challenges for each phase. It helps organizations better navigate uncertainties, anticipate challenges, and achieve success in their strategic planning. Find a link in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.