The Trump administration’s cuts to a sexually transmitted infection lab at the Centers for Disease Control and Prevention (CDC) comes as some states, such as Wisconsin, announce enormous increases in syphilis.
Syphilis mitigation is just the latest example of work in sexually transmitted infections (STIs) that will be affected by the lab’s closure, as the Trump administration discards expert leadership and programs that surveil, test and research STIs amid chaotic government cuts.
“This is the Cultural Revolution 2.0,” said Gregg Gonsalves, an associate professor of epidemiology at Yale University’s school of public health, about the mid-20th-century political upheaval in China. Gonsalves is an expert in modeling the impact of public policy on infectious disease.
“The 30,000-foot view is this is not necessarily about HIV and STIs – although it is because they have a particular animus against it – they are looking to gut the ability of federal institutions to do their jobs,” he said.
Authorities in Wisconsin announced that syphilis cases had risen 1,450% in the state since 2019, the public health director said in a statement on Thursday. The trend mirrors a nationwide increase that officials at the CDC described only two years ago as a “heartbreaking” epidemic.
Congenital syphilis is also on the rise. The secondary infection occurs when a fetus is infected with syphilis in the womb. The condition is both highly preventable and devastating. Experts consider even one case a sign of failing health infrastructure, because it is easily treated with a single-dose antibiotic.
“We have a raging congenital syphilis epidemic in this country,” said David C Harvey, executive director of the National Coalition of STD Directors. “CDC’s STI lab provides an important backup to confirm results and to tackle difficult diagnosis. We know this is going to negatively impact on our ability to prevent babies being born with syphilis and to prevent stillborns from syphilis.”
Sexually transmitted infections (STIs) are among the most common diseases in the world – and the most marginalized. Years of flagging public health funding already meant that the US had some of the highest STI rates in the developed world in four diseases tracked by public health authorities: chlamydia, gonorrhea, HIV and syphilis.
The most recent data shows gonorrhea slightly decreased and chlamydia remained stable, according to a report from the CDC from 2023. New HIV infections decreased 12% between 2018 and 2022, because of new government supports, some put into place during Trump’s first term. Trump pledged to eliminate HIV in the US in his 2019 State of the Union address.
“In the short term, we’re going to see a rebound in a lot of this because public health departments are already suffering under the clawback, and people are having to let go of staff and programs that support [pre-exposure prophylaxis for HIV],” said Gonsalves. “All this other stuff is collapsing.”
Experts have pointed specifically to the highly specialized lab at the CDC, formally called the STD Laboratory Reference and Research Branch, as one of the most shocking cuts.
The lab worked on syphilis and multidrug-resistant gonorrhea, sometimes called “super gonorrhea”. It had the “highest degree of viral hepatitis expertise of any public health laboratory in the world”, according to a letter from the Association of Public Health Laboratories, and the nation’s only capacity to use a PCR test for syphilis, which primarily still relies on mid-20th-century serology testing. The work was not replicated anywhere else in federal or state government, or in private universities or labs.
All 28 employees were laid off by the Trump administration on 1 April, alongside a total of roughly 10,000 colleagues in cuts imposed by the health secretary, Robert F Kennedy Jr.
Together with cuts by the billionaire Elon Musk’s unofficial “department of government efficiency”, the federal Department of Health and Human Services (HHS) has lost nearly a quarter of its 82,000-person workforce.
“This is very concerning to our ability to maintain a functioning public health system and a world-class system that protects the American people,” said Harvey. “We don’t know what’s going to happen, and we’re very worried about this.”
Updating syphilis testing was an especially important project for the lab. Although syphilis is easy to treat, it can be difficult to diagnose, even spawning its own medical aphorism: “He who knows syphilis knows medicine.”
Symptoms of the highly invasive bacterium can be mild or go unnoticed for years, causing feared outcomes such as dementia-like symptoms or blindness. Congenital syphilis is a special horror: up to 40% of infants who contract the disease in utero will be stillborn or die. Those that survive can suffer lifelong disabilities including seizures, cataracts and deafness.
In comments made to the Guardian just before Trump was elected, Dr Jeanne Marrazzo, the director of the National Institutes of Allergy and Infectious Diseases, said she was looking forward to developing new diagnostics for syphilis and researching vaccines for gonorrhea.
“We’ve made commitments to things we can’t back down on – and STIs are a great example,” Marrazzo said. “One of the most frustrating aspects of syphilis in the field is making a diagnosis of active syphilis and then monitoring the response to therapy … So we desperately need new diagnostics.” As part of Kennedy’s cuts, Marrazzo was placed on administrative leave.
Similarly placed on leave was Jonathan Mermin, former director of the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP). In 2023, Mermin described congenital syphilis as “an unacceptable American crisis”.
In addition to work on syphilis tests, the CDC lab was charged with investigating cases of antimicrobial-resistant gonorrhea. Gonorrhea can only be reliably treated with one antibiotic: ceftriaxone. While resistant strains of the infection are rare, they are rising globally – a fact that is only known because the CDC lab was one of three globally that worked alongside the World Health Organization (WHO) to monitor the disease. Trump pledged to withdraw from the WHO as one of his first acts as president. It is not clear what will happen to the 50,000 samples of gonorrhea isolates the lab held in freezers.
“They’re irreplaceable,” a former CDC employee, who asked not to be named for fear of reprisal, told Stat News. “Are they just going to autoclave the whole thing and destroy it?”
Cuts imposed by Doge and Kennedy have also eviscerated expertise and funding for STI research and testing beyond the CDC. The administration’s clawback of more than $11bn ended grants to study STI testing and prevention among trans women in Florida; efforts to improve the health of mothers and babies in the Mississippi Delta region (an area especially hard-hit by congenital syphilis); and a grant to study the best way to tackle the HIV-syphilis “syndemic” in Chicago. HIV awareness campaigns and studies into prophylactic treatment for chlamydia – among many other programs.
“The biggest concern about containing syphilis is the erosion of our ability to ensure people who have the disease or who have come into contact with the disease are taken care of medically,” said Brandon Kufalk, supervisor of the STI unit at the Wisconsin department of health services, about cuts to health infrastructure.
“We want to maintain our capacity to ensure proper medical care is given, that the correct medications are available to medical facilities, to perform contact tracing on individuals, and communicate what is happening with syphilis in our state effectively,” he said.
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