The stakes are unusually high. Syphilis rates have climbed sharply in the United States over the past decade, with congenital cases — passed from pregnant parent to infant — rising at an alarming pace. Public health agencies have urged wider screening, but the tools to do that work, and the supply of the drug that cures the infection, are under strain.
Reaching People Outside the System
The Park Boulevard research office sits in a neighborhood where the gap between clinical care and daily survival is wide. Researchers there have turned to a straightforward incentive model: small cash payments and snacks in exchange for participation in surveys and, when participants agree, blood draws for syphilis screening.
For one participant, identified in research records as GB, the offer was enough to walk over from the tent city where she lived. At 47, she had been using methamphetamine since 2021, snorting rather than injecting it, and supporting herself by collecting cans and bottles — aluminum fetching roughly $1.66 per pound, a rate that meant collecting hundreds of containers to earn $20. The $20 survey payment and a basket of granola bars, rice crispy treats, and fruit gummies were a meaningful draw.
GB had never had blood drawn. She was terrified of needles. When the researcher asked whether he could draw blood, the request sat at the edge of what she was willing to do. Her hesitation reflects a broader challenge in syphilis surveillance: the people most at risk are often those least connected to clinics, and a blood draw — routine in most medical settings — can be a barrier that stops screening before it starts.
The Drug Behind the Response
Penicillin G benzathine, the long-acting injectable antibiotic that has been the standard syphilis treatment for decades, has been in intermittent shortage. The U.S. Food and Drug Administration has tracked supply constraints on the drug, and clinicians in some regions have reported difficulty obtaining enough doses to treat patients on schedule. For early syphilis, a single injection is typically enough. For later stages, the regimen stretches across three weekly shots — and any gap in supply can interrupt that course.
When treatment is delayed, the infection continues to spread. Syphilis is transmitted through direct contact with a syphilis sore during sexual activity, and people often do not notice early symptoms. That silent progression is part of what makes the outbreak difficult to contain: people can carry and transmit the infection for weeks or months before any visible sign appears.
Federal Constraints on Research
Alongside the drug shortage, researchers studying syphilis transmission are contending with federal constraints that shape how they recruit participants, collect samples, and share data. The specifics vary by funding stream and institutional review board, but the cumulative effect is that studies move more slowly than the outbreak itself.
Researchers on Park Boulevard and in similar efforts elsewhere have had to build trust one participant at a time — offering food, coffee, and small payments — while navigating rules designed to protect participants but that can also slow enrollment. For a population that moves frequently, has no stable address, and may be wary of any institution that asks for personal information, the window for screening and follow-up is narrow.
Why Congenital Syphilis Alarms Clinicians
The sharpest concern among public health officials is congenital syphilis, which occurs when the infection is passed to a fetus during pregnancy. Untreated, it can cause stillbirth, neonatal death, or severe lifelong disability in surviving infants. Rates of congenital syphilis have risen sharply in recent years, and the Centers for Disease Control and Prevention has identified gaps in prenatal screening as a key driver.
The same drug shortage that complicates adult treatment directly affects pregnant patients, for whom penicillin is the only recommended therapy. Desensitization protocols exist for patients with penicillin allergies, but there is no alternative antibiotic with the same evidence base for pregnancy. When supply falters, the consequence can be measured in infant outcomes.
What Happens Next
Public health watchers will be tracking three things in the coming months. First, whether the penicillin G benzathine shortage eases — manufacturers have signaled efforts to increase supply, but timelines remain uncertain. Second, whether federal research constraints loosen enough to let studies like the Park Boulevard effort scale faster, or whether researchers will need to keep working within the current rules. Third, whether screening can reach enough people like GB — people outside the clinical system, wary of needles, and focused on day-to-day survival — to slow transmission before the outbreak grows further.
The Park Boulevard model suggests one path forward: meet people where they are, offer something tangible, and let the blood draw be a request rather than a requirement. Whether that approach can outpace both the infection and the constraints around it is the question now hanging over the response.
— Aisha Mensah, health desk, AXO News