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In just four years, the rate of syphilis infections has nearly doubled in Pennsylvania and New Jersey and tripled in Delaware.

A new report from the Centers for Disease Control and Prevention shows that infections are up across the United States, “signaling an urgent need for swift innovation and collaboration” in sexually transmitted infection prevention efforts.

It’s a trend that public health experts call worrying. They are urging for significant investments in sexual health education, testing and treatment to address the problem.

“I think a lot of us think about syphilis as a thing of days of yore, like an old thing that is not really around anymore,” said Dr. Stacey Trooskin, executive medical officer of the Mazzoni Center in Philadelphia. “But we see it in practice all the time, every day. All you have to do is look for it.”

In Pennsylvania, there were 4,486 cases of syphilis in 2022 — a rate of 34.6 cases per 100,000 people. The state’s rate of infection was 18.8 in 2018.

Local and federal health experts attribute the rise in cases to multiple factors: COVID-19 pandemic disruptions to health care screenings, decreased use of condoms among teenagers, and higher sexual health risks associated with drug use.

The early asymptomatic nature of this infection could also contribute to its spread, Trooskin said. People with a syphilis infection may eventually develop painful ulcers, sores and rashes.

“You may not notice that you have a painless ulcer, or perhaps the ulcer is in a place that you can’t visibly see it,” Trooskin said. “And so you don’t know, and it really takes being screened in order to be diagnosed and treated.”

But stigma around sexually transmitted infections continues to be a barrier to screening and testing.

“That somehow people feel that they’ve done something wrong,” Trooksin said. “Or there’s a blame or shame associated with being tested or treated for an STI.”

Syphilis can be easily treated and cured, but when it goes undetected, Trooskin said it can have devastating health effects.

“Not just in pregnant people who then have perinatal exposure for their infants, but also for individuals themselves, it can develop into neurosyphilis,” she said, which is a life-threatening complication to the brain and spinal cord.

Rates of congenital syphilis among infants, which happens when a mother transmits the infection to an unborn baby in utero, are also up in many states, including New Jersey.