If STD prevention and control is a joint responsibility between federal, state, and local governments—which it is—then is the conclusion that we’re failing? With regard to syphilis, the answer is yes. Indeed, even one case of congenital syphilis is seen as a failure of the public health and health care system. However, most of us in public health understand it’s more complicated than that. My goal here is not to point fingers or assign blame but to take a closer look at a major influencing factor. Reversing these trends means addressing what’s caused them in the first place, because if we don’t do it now, these increases will only continue and worsen. We cannot afford to let this spiral further out of control.

Every story has a beginning, and in our case, revisiting the scope of our work is an important starting point to understand what has happened with syphilis.

STD prevention is funded by all three levels of government, supporting a wide variety of activities. Federal dollars fund the core public health functions of assessment, assurance, and policy development through the support of surveillance and disease investigation. State and local governments provide the vital STD clinical care for individuals living in their jurisdictions needing timely and confidential STD preventive services. Each year, state- and locally funded STD clinics identify up to a quarter of syphilis cases (not to mention other STDs, including HIV). In addition, other on-the-ground services such as contact tracing, linkage to care, health education, and STD screening outside of clinical settings are provided by state and local STD prevention programs. In a perfect world it would be this simple: we, the public sector, unite and take down STDs one case at a time. In reality, we know very well that it’s much more challenging.

The erosion of the public health infrastructure threatens our ability to successfully prevent and control STDs. In fact, while there isn’t a magic bullet to solving our problems with syphilis, it’s fair to say that our ability to prevent STDs is only as strong as the public health infrastructure that exists to support it. It’s alarming that in 2012, 52% of state and local STD programs experienced budget cuts, meaning reductions in clinic hours, contact tracing, and screening for common STDs. In that year alone, we estimate that 21 local health department STD clinics closed.

State and local programs continue to report decreases in STD staffing, clinicians, and Disease Intervention Specialists (DIS). While these are all concerning, the reductions in DIS and closure of STD clinics are especially harmful to STD prevention efforts.

Yet, as the late 1990s taught us, increasing resources for prevention efforts can reduce syphilis infections.

Some may cite that the Affordable Care Act (ACA) makes these realities less troubling, but we know that publicly funded STD services remain critical for millions. ACA has reduced the number of uninsured people who need STD clinical preventive services, but 4.6 to 4.7 million people are still uninsured and are expected to need STD services annually through at least 2023. This year, chlamydia-related services alone for this group will cost $150 million. This figure does not even include other STD screening, testing, and treatment costs for HIV, syphilis, or gonorrhea. Findings from a recent survey also indicate that roughly half of all STD clinic patients do have insurance. Among the many reasons that both insured and uninsured patients report seeking STD services from an STD clinic, expert care and confidentiality are at the top of the list.

We must learn to adapt, along with the continuously evolving STD prevention landscape, for the health of our communities. We’re all experiencing growing pains in this new era, and we all face challenges that require tough choices. Most urgently though, we must tackle the return of syphilis. Here at CDC, we’re spreading the word about the dangers of congenital and ocular syphilis and advising clinicians and STD programs on how to best protect their patients. In January, we hosted a syphilis summit—meeting with some of the greatest minds in public health, including leading syphilis experts—to identify the existing challenges and needed actions to undo the rise in this potentially deadly disease. One thing is abundantly clear, the disease-siloed interventions of the past are outdated and ineffective. Tackling the competing priorities we face in an ongoing STD syndemic requires a holistic approach to sexual health that addresses other co-occurring conditions such as substance use.

Together, it’s essential for all levels of government to maximize efforts and resources. CDC is hard at work to help us all find ways to do more with less. For example, we’re providing evidence for the effectiveness of various STD control interventions, so that STD programs can determine which interventions will work best for them. We’ve also launched Improving Sexually Transmitted Disease Programs through Assessment, Assurance, Policy Development, and Prevention Strategies, or STD AAPPS. More than a funding mechanism, STD AAPPS provides grantees the flexibility to get the most out of every prevention dollar, and provides a framework for STD programs to leverage opportunities created by the transformed healthcare environment. CDC also provides funding for the National Network of STD Clinical Prevention Training Centers (NNPTC). The PTCs are a group of training centers created in partnership with health departments and universities that provide educational opportunities for health professionals in the areas of sexual health, and also deliver clinical decision support through their STD Clinical Consultation Network.

It’s not all bad news, as you can see from these success stories made possible by state and local STD programs. These stories are a reminder that our work matters and that we must capitalize on every moment. Even something as simple as STD Awareness Month is an opportunity for CDC and partners to reach individuals with health information that could shape a better and healthier future, not to mention the opportunity to reenergize those in the field who work so hard for so many.

This April, and all year long, we request that you join us to help spread the word that STD prevention doesn’t have to be complicated. We just need everyone to Talk. Test. Treat.