Syphilis Makes a Comeback

Syphilis is surging through America at an alarming rate. Peaking in 1990, syphilis rates were down 86 percent in 1998 following an intense national response. After this success, the Centers for Disease Control and Prevention felt confident in developing the Syphilis Elimination Effort.

This program was proposed at a time when completely eliminating syphilis in the U.S. seemed like an achievable goal. But after 2001’s nadir, infection, rates again began to rise and SEE was no longer a reality. It’s important to understand what syphilis is, what it means for people who have it, and why it’s on the rise. Here are some facts:

Syphilis is a sexually transmitted infection that is characterized by genital, anal, or oral ulcers.

There are four stages to the disease. In the first stage, known as primary syphilis, those infected experience a painless, single sore in one of the areas mentioned above. Generally, the sore develops anywhere from 10 to 90 days after initial infection. This sore, if left untreated, usually disappears within a month after first appearing, and then the disease progresses to the second stage, or secondary syphilis. Secondary syphilis occurs after the infection spreads through the bloodstream and therefore is no longer isolated to the initial infection site. Still curable, secondary syphilis is characterized by a number of symptoms presenting about two to eight weeks after the first stage.

Some of these symptoms include: rashes, sore throat, fever, headaches, fatigue, muscle aches, loss of appetite, and joint pain.

Syphilis is completely curable with penicillin in the primary and secondary stages.

The latent stage of syphilis occurs after the secondary, when a person has no symptoms although the infection is still present in their body. The final stage of untreated syphilis is tertiary syphilis. Appearing anywhere from 10 to 30 years after the initial acquired infection, tertiary syphilis affects a person’s organ systems. This can range from the brain to the heart to a person’s nerves. Tertiary syphilis can be fatal. The latent and tertiary stages of syphilis are not treatable.

Those with syphilis have a higher risk of contracting HIV.

When a person is infected with syphilis (or any STI) their body’s immune system sends CD4 cells, also know as T cells, to the infected area. These cells are white blood cells that activate to aid the immune system in fighting the infection. HIV is a virus that attacks a person’s immune system. So if a person with syphilis is exposed to HIV, these activated cells are extremely susceptible to being infected with HIV. In short, the body’s natural response, to send CD4 cells to fight the syphilis infection, can be ambushed by HIV.

Other chronic consequences of syphilis can include:

Neurosyphilis: when the syphilis infection invades the nervous system. This can happen at any stage. This causes a wide range of symptoms — from altered behavior, to paralysis, to dementia.

Ocular syphilis can happen at any stage and effects the eyes. Vision changes or blindness can result.

Congenital syphilis is when a mother transmits the infection to her unborn child. According to the CDC, 40 percent of cases in which the mother has untreated syphilis result in infant death. Congenial syphilis leads to birth defects such as deformed bones, meningitis, and brain and nervous system problems.

So why is syphilis on the rise?

Some theories cite the use of dating apps for quick hookups, while others claim that more people are having condomless sex. Dating apps such as Tinder and Grindrhave facilitated a multiple-partner, hookup culture. It is common sense that the more sexual partners a person has, the higher the likelihood is that they will be exposed to an STI. But the latter is true too. People are having more condomless sex.

Condom use has decreased since the 1990s. Younger generations of gay and bisexual men may not be as cautious as older men when it comes to HIV prevention. Use of PrEP, the antiviral strategy that prevents HIV with a pill is increasing but does not protect against other STIs. Some experts say this is causing a false confidence and creating a decrease in condom use.

There’s another, more ominous reason syphilis rates are on the way up: budget cuts! Public health in the United States is historically underfunded at both the federal and state level. Because of this, STI clinics are now few and far between. People used to turn to clinics because they offer anonymous and affordable, or even free, testing and treatment. But just as people are having more condomless sex, more clinics are closing. This irrational ratio is leading to a new epidemic.

It is important for the health care industry to modernize its methods of reaching the public. Telemedicine, a method of patient-doctor interaction via the internet, video chat, or phone, is a new frontier that can be extremely effective in diagnosing STIs due to its ease of use and anonymity. Most importantly, people need to practice safer sex. Using barrier methods, disclosing sexual history to partners, regular testing, and routine self-care can all aid in preventing STIs like syphilis.

DR. OLUSEGUN ISHMAEL has served the medical community for over 20 years. He has worked in academic, hospital, and health insurance settings. He is the founder and chief medical officer of BeSafeMeds, an online platform for the discreet diagnosis and treatment of STIs.