Syphilis cases are on the rise. should i worry

Syphilis is back in the United States. In 2021, total cases of the sexually transmitted disease rose 27 percent to more than 171,000, and the rate hit a 30-year high, according to preliminary data from the Centers for Disease Control and Prevention.

The increase is part of a worrying trend of increased sexually transmitted infections, but syphilis is of particular concern because it can mimic other infections and some people don’t even know they have it. Even among doctors, knowledge of the disease is low. Congenital syphilis, which affects babies born to mothers who had the disease during pregnancy, is also on the rise. Here are answers to some common questions about the disease.

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Q: What are the symptoms of syphilis?

A: Syphilis is caused by a bacterium called Treponema pallidum. The first symptoms are one or more concave sores that usually appear in the mouth or genitals about three weeks after sexual contact with an infected person.

“It can be in the back of the throat. It can be inside the vagina. It can be in the rectum,” said Jeffrey Klausner, a professor at the University of Southern California and former director of the STD Prevention and Control Services at the San Francisco Department of Health. “People may not be very aware of it.”

Experts say the sores are usually painless, can last three to six weeks and go away without treatment, but that doesn’t mean you’re in the clear.

A few weeks after the first sores disappear, you are still infectious and usually a second phase of the infection sets in, with a rash on the hands or feet. Other symptoms may include fever, swollen lymph nodes, sore throat, headaches, patchy hair loss, muscle aches and fatigue. The rash may also be so faint that you don’t notice it.

If a person is never treated, they could experience a third phase weeks or years after contracting the disease, which can damage organs, leading to neurological problems, heart problems, vision loss and death. At this point, the disease is no longer infectious.

Klausner said doctors can sometimes misdiagnose syphilis as a viral infection, rather than a sexually transmitted disease.

“There are fewer and fewer syphilis experts,” he said. “I was a full-time professor of medicine at UCLA for 10 years. We gave about 15 minutes to syphilis.”

Q: What is congenital syphilis?

A: Syphilis can be transmitted to the fetus during pregnancy. Reports of congenital syphilis reached near-historic lows between 2000 and 2012, but in recent years, cases have begun to rise. In 2012, 334 babies were born with congenital syphilis. By 2021, according to the CDC, there were nearly 2,700 cases, a sevenfold increase in less than a decade.

Matthew Golden, professor and director of the Center for AIDS and STDs at the University of Washington, said congenital syphilis is “the most devastating consequence” of the “syphilis epidemic.” In addition to causing stillbirths, the disease can cause bone deformities, jaundice, blindness and deafness in newborns.

Q: Who is most at risk for syphilis?

A: Anyone who is sexually active could get syphilis, and the risk is highest among those who have multiple partners. The CDC recommends regular testing among sexually active gay and bisexual men, people with HIV, and people taking pre-exposure prophylaxis (PrEP medication) to help prevent HIV. Syphilis testing should also be done during pregnancy.

Some experts recommend a broader approach to testing: “The most important message is if you are sexually active, especially if you are sexually active with multiple different partners during the year, is to talk to your doctor or find an STD clinic where can go and you can be evaluated and tested,” said Michael Angarone, an infectious disease specialist at Northwestern University.

Hilary Reno, medical director of the St. Louis County Sexual Health Clinic. Louis in Missouri, said the stigma associated with sexually transmitted infections often makes people think they won’t be the ones to contract a disease.

“Especially with syphilis, it amazes me how many people think that’s gone,” Reno said. “They don’t consider it something they can get during sex.”

Syphilis is not spread through casual contact, such as touching doorknobs, clothing, or using the same toilet seats as someone who is infected.

Q: Why is syphilis on the rise again?

A: There are probably a number of factors behind the increase. Some public health experts say fewer people are using condoms, in part because the growing use of drugs to help prevent HIV has reduced the incentive. They also noted a link between the rise in opioid and methamphetamine addiction in the United States, which is associated with risky sexual practices.

In the early 2000s, there was a campaign to eradicate syphilis from the country. But public health experts say federal funding eventually ran out. “The whole infrastructure for preventing and controlling things like syphilis has been completely eroded,” Klausner said. “Many free STD clinics in many cities and counties are closed.”

Golden said that in Washington, where he is the director of an STI and HIV center, health departments “don’t have the capacity to keep up with the workload” and the number of cases coming in.

“It’s out of control. It’s terrible. We’re having huge problems,” he said.

Q: How do you get tested for syphilis? What is the treatment?

A: Syphilis is diagnosed with a blood test, which you can do if you go to your doctor or a clinic. There are also home tests that you can buy from a pharmacy or order by mail.

Home tests, which use a finger prick to collect a blood sample that is mailed to a lab, allow for privacy but can be expensive. Everlywell offers a single test for syphilis for $69 or a kit that tests for multiple STDs for $169. MyLabBox sells a single test for $89 or a “love box” to screen couples for eight diseases for $499. Let’s Get Checked offers home test kits for multiple STDs including syphilis, ranging from $149 to $249.

Syphilis is usually treated with one or more penicillin injections, depending on the stage of the infection. If you’re allergic to penicillin, there are also other antibiotic treatments, Reno said.

Q: Can I get syphilis again?

A: Yes. If you have been treated for syphilis, you can get the disease again. You do not develop an immunity to bacteria after an infection.

“People get syphilis again all the time,” Golden said. “In fact, a strong predictor of syphilis is that you’ve had it before.”

Q: Is there a vaccine against syphilis?

A: Not yet. The National Institutes of Health and the Gates Foundation are funding research into a vaccine, said Jonathan Parr, a professor of infectious diseases at the University of North Carolina.

Syphilis is a particularly difficult disease to vaccinate because the bacteria have adapted to escape our immune system. It replicates slowly in the body and is very good at moving from person to person, Parr said. But recently researchers have found ways to more easily grow bacteria in the lab and study their DNA.

“Syphilis has lagged behind other infectious diseases because of the challenges of working with this bacteria in the past, but I’m optimistic,” he said. “We’re about to see real progress going forward.”

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