The sudden withdrawal of syphilis in gay men is most likely related to preventive antibiotic use

The health care workers charged with fighting a long-lost battle against sexually transmitted infections are now faced with a new, unfamiliar outlook: hope.

After rising to record levels virtually every year this century, total diagnoses of the three major bacterial STDs have risen since the Covid pandemic. According to an STD surveillance report from the Centers for Disease Control and Prevention, total diagnoses fell 2% from 2022 to 2023 to 2.46 million new cases. published on Tuesday.

And importantly, the number of diagnoses of primary and secondary syphilis – the most contagious stages of the infection – fell by 10% last year to 53,000 cases.

The decline was driven by a 13% decline in such syphilis diagnoses among gay and bisexual men, who are about 2% of the adult population, but have historically accounted for almost half of such cases.

STDs also spread disproportionately among young people and racial minorities. Just under half of the top three bacterial STDs were diagnosed among 15 to 24-year-olds last year. Nearly a third of the cases occurred among blacks, who make up 13% of the population.

Overall, gonorrhea fell 7% to 601,300 cases last year; that followed a 9% decline last year. The number of cases of all stages of syphilis increased by 1% to 209,250 diagnoses. Chlamydia remained stable at approximately 1.65 million cases between 2021 and 2023.

“I think we are at a turning point, and it is important that we move forward and take advantage of innovations and investments in STD prevention,” said Dr. Laura Bachmann, chief medical officer of the Department of STD Prevention from the CDC.

The six other infectious disease experts who spoke to NBC News about the CDC report said they believed the sudden turnaround in syphilis diagnoses among gay and bisexual men was likely an early signal of the eager adoption of a new one, proven protocol where the oral antibiotic doxycycline is used for STD prevention.

“That’s a big reason for celebration. And I’m a little surprised that we’re already seeing that trend nationally,” said Dr. Julie Dombrowski, a professor of medicine at the University of Washington.

Pointing to a recent decline in syphilis among men in Seattle, she added: “We’ve certainly seen this on a local level.”

Some experts expressed hope that doxycycline use among gay and bisexual men would have a positive spillover effect among women of childbearing age.

Syphilis poses the greatest threat to newborns, for whom it can cause serious birth defects and death. While the number of STD cases in newborns increased by 30% annually in recent years — deeply troubling public health experts — the upward trend has slowed down. Such a promising shift was apparently driven in part by nationwide efforts to achieve it increase testing among pregnant women.

In another hopeful development a shortage That started in early 2023 of the only recommended treatment for syphilis in pregnant women, Pfizer’s Bicillin-LA, has decreased.

In recent years a trio randomized controlled trials have shown that instructing gay and bisexual men and transgender women to take one 200-milligram tablet of doxycycline within 72 hours of condomless sex reduces the number of cases of chlamydia and syphilis among them by more than 70% and of gonorrhea by about 50 % decreases.

The protocol is known as doxyPEPwhich is an abbreviation for doxycycline post-exposure prophylaxis.

The San Francisco Department of Public Health was the first to recommend doxyPEP for gay and bisexual men and trans women. in October 2022. The CDC followed in June. That includes health departments in other major cities, such as Chicago And New Yorkwhere the LGBTQ community health centers have started offer doxycycline to patients.

A study of doxyPEP among cisgender women in Africa could not demonstrate efficacy. However, one does exist ongoing lawsuit in American women.

Thanks to penicillin, the country made steady progress in the fight against syphilis after World War II. In the mid-1990s, public health leaders were concerned with the possibility that the STD could be eliminated.

But the approval of an effective HIV treatment in 1996 reduced the public’s fear of AIDS. That helped activate one long decline in condom use especially among gay and bisexual men. The next one approval of the HIV prevention pill – called pre-exposure prophylaxis or PrEP – only accelerated the decline in 2012.

Bacterial STDs increased sharply accordingly.

DoxyPEP offers a promising form of harm reduction. It is inexpensive and well tolerated, and it can easily be incorporated into the routines of many gay and bisexual men for receiving prescriptions to treat or prevent HIV.

Early analyzes suggest doxyPEP is a sleeper hit in that population.

A study published This month, the journal Sexually Translied Diseases found that San Francisco’s guidelines on the preventive tool were linked to a decline in STDs among local men. A study published Next month’s edition of the magazine found that of about 900 gay and bisexual men recruited for a study through hook-up apps, half had heard of doxyPEP and almost all expressed interest.

A spokesperson for PrEP-focused telehealth service MISTR told NBC News that since the company began offering doxyPEP in April, three-quarters of users who have since filled PrEP prescriptions have also requested and received doxycycline. (The rep declined to provide the number of users this entailed, but said MISTR “serves more than 450,000 patients in all 50 states, DC and Puerto Rico.”) Since then, the overall quarterly STD positivity rate among MISTR users has plummeted from 12% to 6%.

In November 2023, the Food and Drug Administration approved the first home tests for gonorrhea and chlamydia, which public health experts hope can also help fight the spread of STDs.

And in July, researchers presented findings at a global HIV conference in Munich on studies in which gay and bisexual men in Canada and female sex workers in Japan were instructed to take 100 milligrams of doxycycline daily. The protocol, called doxyPrEPshowed generally similar efficacy in preventing STDs compared to doxyPEP studies in gay men.

Research is underway to address concerns that increased use of doxycycline to prevent STDs could fuel the rise drug-resistant pathogen crisis. So far, researchers have found reassuring signs.

STD prevention experts also worry that doxyPEP, like HIV PrEP, will prove disproportionately popular among whites and thus only expand. racial differences in case of STD transmission. Research is being conducted to analyze trends in doxyPEP use so that promotion of the intervention can be targeted where the need is greatest.

Public health experts have attributed this century’s rise in STD rates, at least in part, to: steady reduction from state and local public health clinics.

Dr. Jeffrey Klausner, an infectious disease expert at the University of Southern California, who led the first study To demonstrate the efficacy of doxyPEP, calls were made for renewed spending on STD-related care.

“If Trump is going to make IVF – in vitro fertilization – free,” Klausner said of the emphatic campaign promise“He should make testing and treatment for STDs free.”