Why are syphilis cases increasing in the United States? This is what the doctors say



Two decades ago, syphilis was almost eradicated in the country. But despite the best efforts of medical professionals and advocates, the disease has never completely gone away.

Six years ago, cases of syphilis and other sexually transmitted diseases began to spread at a faster rate: between 2015 and 2019, cases of chlamydia, gonorrhea and syphilis increased by 30%, according to the Centers for Disease Control and Prevention (CDC). Even more alarming, cases of syphilis in newborns (also known as congenital syphilis, which can cause major health problems in infants) have almost quadrupled during the same period.

Almost 130,000 cases syphilis at all stages were reported in 2019, reports the CDC, an increase of 11.2% from the previous year. The infection also has a disproportionate impact on already vulnerable populations: Blacks, Native Americans and Hispanics are most at risk, as are men who have sex with men.

Although the CDC has yet to finalize the 2020 figures, the agency has already announced that there was more cases of congenital syphilis last year than in 2019. But why is syphilis, an easily treatable infection, on the increase? And what to do against its spread? Here, the doctors explain everything you need to know about sexually transmitted infection.

What is syphilis and what are its symptoms?

Syphilis is a sexually transmitted infection that is most commonly spread during vaginal, anal or oral sex, depending on the doctor. CDC, when the skin touches the infected skin. It progresses in three stages, explains Latasha Murphy, MD, gynecologist and surgeon at the Mercy Medical Center Gynecology Center in Baltimore: primary, secondary, latent and tertiary.

Primary syphilis is characterized by one or more round, painless sores, called chancre, at the site of infection, says Dr. Murphy. Chancres usually occur on or around the genitals, anus, or mouth, the CDC explains. Secondary syphilis usually involves a rash on one or more parts of the body, including the palms and soles of the feet, says Dr. Murphy, along with general symptoms like fever and swollen lymph nodes. (Both of these steps can be light and easy to miss.)

Next is the latent stage, which is asymptomatic and occurs without treatment, says Dr. Murphy. Finally, the tertiary stage, which can occur after as little as one year or as long as 30 years – is the last stage of syphilis infection. Most people with syphilis don’t reach this stage, but those who have problems with several organ systems, including the brain, eyes, heart, and blood vessels, says Dr. Murphy. “Tertiary syphilis can be very dangerous and even fatal,” she warns. Organ damage and death are common results of this stage.

What is congenital syphilis?

Although the vast majority of syphilis cases are spread through skin-to-skin contact during sex, says Matthew Hammill, MBCh.B., Ph.D., MPH, M.Sc., an assistant professor of medicine in the Johns Hopkins University School of Medicine and an STD researcher, others occur during pregnancy. Congenital syphilis occurs when infected mothers pass it on to their babies.

“Every baby born with congenital syphilis is a failure of the health care system.”

The effects of congenital syphilis can be “devastating” on babies, mothers and families, explains Hammill. The infection can cause miscarriage, stillbirth, premature birth, low birth weight and death soon after birth, depending on the doctor. CDC. On 40% babies born to mothers with untreated syphilis will die.

Those who survive could have deformed bones, severe anemia, enlarged organs, jaundice, blindness, deafness and meningitis, according to the CDC. Symptoms of congenital syphilis usually develop within weeks of birth, but may take years to appear. Babies can be treated, but it has to happen right away. Congenital syphilis rates have been increasing every year since 2013, according to the CDC.

“Every pregnant woman should be tested for syphilis during pregnancy,” advises Dr Murphy, preferably during her first prenatal visit to the doctor. Treatment of penicillin infections in early pregnancy “prevents having syphilis positive babies born to these mothers.”

“These cases are 100% preventable,” explains Hammill. “The way I see it, and I think a lot of my colleagues do too, is that every baby born with congenital syphilis is a failure of the health care system.”

Can syphilis be cured?

Yes, syphilis can be cured with antibiotics. Although treatment varies by stage, penicillin is the common denominator, says Dr. Murphy. However, treatment cannot repair the damage that the infection has already caused, the CDC warns, which means getting tested regularly to catch it early is imperative.

If you think you have syphilis, it’s imperative that you get tested – without a test, it can’t be treated, says Dr Hammill. If your test is positive, you and all of your sexual partners need to be treated, Dr. Murphy recommends.

Why is syphilis on the rise in the United States?

There isn’t a single reason why syphilis and other STIs are spreading so quickly in the United States. On a personal level, “syphilis is easily spread because the first symptoms are painless and may go unnoticed,” says Dr. Murphy. “Unless the disease is completely eradicated and not nearly eliminated, we run the risk of increasing cases over time. “

But structural forces are also at play. For example, declining investment in public health clinics has left vulnerable communities – those most likely to contract syphilis – without access to sex education and testing. safer screening, says Hammill. “People need a safe place to go,” he explains. “For many people, their primary care provider is a safe place. For others, sexual health clinics are a safe place to go for high quality confidential care. Deprived of these resources, many people have nowhere to turn.

Another factor could be the internet, which has increasingly made it possible for people to seek out sex with partners they might not otherwise have met, says Hammill. The COVID-19 pandemic is yet another facet of the most recent increase in syphilis, he explains, as funds and workers have been diverted to treating SARS-CoV-2 patients. In reality, investigation as of January found that a third of state and local STD staff had been assigned to COVID-19 response efforts.

To curb the spread of syphilis and start to bring down the numbers, it is imperative that sexually active people get tested, especially people like pregnant women and men who have sex with men. In fact, says Hammill, most people with sexually transmitted diseases don’t know they have them because not everyone develops symptoms. Safer sex practices like using condoms can also reduce the risk of coming into contact with a syphilis sore, making transmission less likely.

But it will take a change at the structural level to have a greater impact, explains Hammill; developments such as increased testing, community education, and STI de-stigma helped healthcare professionals almost eradicate syphilis 20 years ago. With the right tools, they can start over, and not too soon.

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