A magazine for friends of the Warren Alpert Medical School of Brown University.

How do we stop the syphilis surge?


Ask the Expert: Philip Chan, MD, MS

Syphilis cases have soared 80 percent since 2018, according to the CDC—to the highest rate of new infections since 1950. Associate Professor of Medicine Philip A. Chan RES’09 F’11, MD, MS, who has dedicated his career to preventing and treating HIV and other sexually transmitted infections, says a lack of testing and resources, along with declining condom use, have created a perfect storm for syphilis, once nearly eliminated in the US, to come roaring back. But Chan—who is also the chief medical officer of the LGBTQ+ clinic Open Door Health and a consultant medical director for the Rhode Island Department of Health—sees a glimmer of hope in a common antibiotic.

For gay, bisexual, and other men who have sex with men, we have pretty aggressive testing recommendations. For the cisgender, heterosexual population, they’re not as strong—and now we’re seeing it spread to that population. There are clear recommendations that all pregnant women be screened at least once, but a significant number of women have inadequate prenatal care—which has led to, among other things, out-of-control rates of congenital syphilis. We’ve also been seeing condom use decline, due to changing social norms, oral contraception, PrEP (pre-exposure prophylaxis for HIV)—there’s a lot of reasons. We’re also seeing the results of chronically underfunded prevention and sexual health and STI care. To get a handle on the syphilis epidemic, we really need the primary care community to be proactive about screening, especially in at-risk populations.

One thing that many people are excited about that may help address syphilis and other bacterial STIs is doxy PEP. This is the hottest thing in STI prevention at the moment. Studies last year showed that doxycycline, when taken as post-exposure prophylaxis after sex, can prevent syphilis 80-plus percent of the time. It also prevents chlamydia and gonorrhea. The CDC released draft recommendations for men who have sex with men and trans women in October; there’s no data yet for cisgender, heterosexual populations. But a lot of us are optimistic that doxy PEP will be a game changer for STI prevention.

Update: In June 2024, the CDC finalized its doxy PEP guidelines, recommending the therapy for men who have sex with men and trans women.


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