The French and Italians once blamed each other for the creation of syphilis, officials viewed it as a moral incentive to maintain sexual propriety, and California required cases to be reported by number rather than name to conceal the identities of “ sinful” sufferers.1 The infection often went undetected, causing neurological and psychiatric problems chronicled in the lives of the rich and famous: Eduard Manet, Paul Gauguin, Vincent van Gogh, Ludwig van Beethoven, Robert Schumann, Franz Schubert, Al Capone, Keats, Baudelaire, Dostoyevsky, and Oscar Wilde.2 Later, diagnosis and treatment changed. Advances in science and medicine, if not in the reduction of stigma, dramatically cut reported rates of syphilis,3 and public health authorities had major successes in curbing Sexually Transmitted Diseases (STDs) over the second half of the twentieth century. In 2018, 1,306 infants in the United States contracted syphilis, a 185 percent rise since 2014.
The CDC, in a recent report, is now sounding the alarm over astonishingly large increases in the prevalence of STDs. Cases have now increased for the fifth straight year and reached another all-time high. One contributing factor is substance use and substance use disorders (SUDs), which are linked to unprotected sex, sex with multiple partners, and other behaviors increasing the risk of STDs. As the CDC predicted, needle use and substance-seeking sex have had major impacts on STD rates: a 2016 report spotlighted 220 counties at elevated risk of HIV from high levels of intravenous drug use. Drinking and use of other substances, which can alter judgment and risk calculations, are also associated with increased chances of contracting STDs.
But in some STD cases, the problem is not a complex one linked to a variety of nuanced and complicatedly intertwined variables. It’s simply a function of not trying. As the CDC’s Director of STD Prevention Gail Bolan notes of infants with syphilis, “This goes beyond data and surveillance, beyond numbers and calculations—we lost 94 lives before they began to an entirely preventable infection.”4