As the 1990s ended, syphilis was on the decline. At least in part due to safer sexual behaviors prompted by the AIDS epidemic,1 the rate of incident syphilis declined to fewer than 4 cases per 100 000 by the year 2000, a historic nadir. Eradication of Treponema pallidum infection in the United States seemed quite possible through concentrated public health efforts in a relatively small number of high-incidence US communities, and the Centers for Disease Control and Prevention (CDC) was developing a national syphilis elimination plan.2 Timing seemed auspicious for eradication efforts to be successful. Now, in 2016, hopes for eradication have long since faded, as have many of the gains realized by the effort. Rates of syphilis have trended steadily upward since 2000, and the CDC’s syphilis elimination efforts officially ended as of December 2013.