Jack Smith woke up one morning to discover a small hard sore on his penis. When it didn’t go away within a couple of days, he went to a clinic where he was examined, was asked about his sex life and was given a blood test, which registered positive for syphilis. He was lucky that the clinic had been made aware, through public service health campaigns, to be on the lookout for the infection.
Smith was shocked and immediately regretted not speaking with his sexual partners about their sexual habits. He also regretted that he’d been careless and wasn’t always using a condom during sexual intercourse. Fortunately, the infection was found at an early stage, and Smith was treated with a dose of penicillin. Had he waited longer, he may have had to have more than one treatment and could have suffered lasting complications.
Smith is not a real person, but stories like this are playing out daily across the country. Syphilis is rising at alarming rates in the United States. It’s affecting all age groups in all regions of the country. Since 2000, the number of syphilis cases has been steadily increasing. Between 2018 and 2022, cases of the disease increased by almost 80% to 207,000 cases, the highest number recorded since the 1950s. In 2022, the number of babies born with syphilis (congenital syphilis) was about 3,755, an increase of 93% in ten years.
“Syphilis is curable in all stages, but there’s a lack of awareness about the causes of the disease, the symptoms of the disease and the availability of testing and treatment,” says Dr. Michael Angarone, an infectious disease specialist at Northwestern Feinberg School of Medicine.
[READ: Guide to Sexually Transmitted Diseases.]
What Is Syphilis?
Syphilis is a common curable sexually transmitted infection caused by the bacteria Treponema pallidum. Syphilis can cause serious health problems if not treated early. It’s transmitted through anal, genital or oral sexual contact, or from a mother with syphilis to a fetus.
Without treatment, which consists primarily of penicillin shots, syphilis can cause serious problems, including damage to the brain, the heart and other organs. It can also cause blindness, deafness, paralysis and sometimes death. About 10% of patients who are not treated for syphilis end up dying from this infection.
Syphilis starts as a painless sore that can go unnoticed. It typically appears on the genitals, rectum and mouth. It is spread through direct contact with sores.
It can be transmitted sexually only in its early stages, but syphilis can stay in the body for many years without symptoms. A pregnant woman can pass it on to a fetus at any stage.
[Read: Living With an HPV Infection.]
The Stages and Symptoms of Syphilis
The syphilis bacterial infection develops in stages, each of which has specific signs and symptoms. While it can be cured at any stage, damage that has occurred before treatment is usually not reversible.
Syphilis is known as “the great mimicker” because of the way it manifests itself — liver inflammation, cardiac issues, rashes and swollen lymph nodes — can be chalked up to so many other causes. Its symptoms and consequences mostly depend on its stage. However, patients can develop neurosyphilis and ocular syphilis — or syphilis that has spread to the nervous system or brain — at any stage of the disease. If that happens, it can lead to serious, irreversible conditions including blindness and dementia.
4 stages of syphilis:
Primary Syphilis. In the first stage of syphilis, sores called chancres appear in the spot where bacteria entered the body. Most people develop one chancre, but some develop more than one. Sores may go unnoticed, as they are firm, round and painless and may be hidden in or around the penis, vagina, anus, rectum, lip or mouth.
A sore usually lasts for about 3 to 6 weeks and heals on its own whether it’s treated or not. Treatment stops the infection from moving to the secondary stage.
Secondary Syphilis. In the second stage of syphilis, while a chancre is healing or a few weeks after it has healed, a rash may appear first on the trunk of your body (chest, stomach, pelvis, back) and can spread to your arms and legs, the palms of your hand and the soles of your feet.
The rash is usually not itchy and may look red, reddish brown and rough. Sometimes, the rash is so faint it’s barely visible.
In addition to a rash, symptoms of secondary syphilis include the following:
— Wart-like sores in your mouth or genital areas
— Muscle aches
— Fever
— Headaches
— Fatigue
— Weight loss
— Swollen lymph nodes
These symptoms will usually go away on their own, but without treatment, the infection will move to the next stage, the latent stage — and maybe to the tertiary stage of syphilis. Symptoms could come and go for months or years.
Latent Syphilis. The latent stage of syphilis is also called the hidden stage because there are no visible signs or symptoms of the disease. They may never come back, but without treatment, the infection can remain in your body for years and you may have serious problems, including brain and cardiovascular disease.
Tertiary Syphilis. Tertiary syphilis is very serious. After latent syphilis, up to 30% to 40% of those who don’t get treatment will progress to the tertiary stage. It usually appears about 10 to 30 years after the original untreated primary infection.
Complications of tertiary syphilis can include the following:
— Brain damage
— Nerve damage
— Eye damage
— Heart damage
— Blood vessel damage
— Liver damage
— Brain and joint damage
— Death
[Related:Health Screening Tests Every Woman Should Have]
What Is Congenital Syphilis?
Congenital syphilis is a severe and often life-threatening infection seen in infants whose mothers were infected and not treated. It can be passed to a baby thorough the placenta or during birth.
When syphilis is transmitted during pregnancy, the result can be miscarriage, infant death or lifelong medical problems. Up to 40% of babies born to a mother with untreated syphilis die from the infection.
At birth, infants with syphilis who survive may have no signs of the disease, but if a baby is not treated right away, serious problems can develop within a few weeks. Those problems include:
— Sores and rashes on the skin
— Fever
— Jaundice or discoloration of the skin and eyes
— Anemia or not enough red blood cells
— Swollen spleen and liver
— Rhinitis or sneezing or stuffed and drippy nose
— Bone change
Later symptoms can include deafness, vision problems, problems with teeth, collapsed nose bridge and impaired brain development.
[READ: How to Cope With Common Sex Problems.]
Who Is at Risk for Syphilis?
Anyone who is sexually active and having vaginal, anal or oral sex without a condom with one or more partners is at risk for contracting the disease.
Due to health inequities like a lack of sex and public health education, inadequate access to health care and cultural barriers to care, syphilis tends to be more common in some racial/ethnic and sexual minority groups.
Dr. Matthew Hamill, a specialist in sexually transmitted infections at Johns Hopkins School of Medicine, says that there have been changes in services for sexually transmitted infections in public health clinics. Since 2003, there has been a 40% reduction in investment in sexual health services with fewer clinics operating.
Increased substance abuse linked to risky sexual behavior is also contributing to the rise of syphilis.
Jessica Leston, a public health professional who has been doing educational outreach work with Native tribes for more than 20 years, says that many Native people get their health care through the Indian Health System, which she says is funded at less than 20% of need. American Indian and Alaska Native people are experiencing the highest rates of syphilis in the U.S., comparable to rates recorded from the pre-penicillin era when syphilis was difficult to cure.
Gay and bisexual men are also disproportionately impacted by syphilis.
Who should get tested for syphilis?
If you think you’re at risk for syphilis, you should seek out a health care provider who can test you for the disease. The following are good reasons to ask to be tested:
— You are regularly having sex with more than one partner.
— You are having unprotected sex (without a condom).
— You’ve had sex with someone who has syphilis.
— You have a partner who has tested positive for syphilis.
— You have another sexually transmitted disease like HIV.
— You are gay or bisexual.
— You live in a community that has high rates of syphilis.
— You are pregnant.
“All pregnant women should be tested for the disease at least twice during pregnancy and at labor and delivery in high prevalence areas,” says Dr. Peter Leone, an infectious disease specialist at the University of North Carolina at Chapel Hill. “The only way to know for sure if you have syphilis is to be tested.”
Proper diagnosis of syphilis involves a discussion of sexual history, a physical exam and blood tests, he adds.
Although not all are highly accurate, home tests for syphilis are now available online, so that you can test yourself in the privacy of your own home.
How Is Syphilis Treated?
Syphilis is curable at any stage when treated with an antibiotic, usually penicillin. The duration and dose of medication needed depends upon the stage of the disease. Damage caused by the infection prior to treatment may not be reversible.
You should also contact anyone with whom you’ve had sex in the last three months to help limit the spread of disease.
After you’ve been treated for syphilis, your healthcare provider will test your blood again to be sure the infection is gone. Be sure to practice safe sex after you’ve been treated, as you can get syphilis again. If you think you’re at risk, get tested again.
“Syphilis is generally very easy and straightforward to treat and responds to one or more injections of penicillin,” says Hamill. “For late syphilis or for syphilis you’ve had for a year or more, you’ll need to get one shot a week for three weeks.”
In addition, Hamill says there is now an antibiotic to take after having sex for people who are at high risk.
If syphilis is so curable, why are the numbers of cases rising?
Although screening and treatment for syphilis is easy, highly accurate and effective, rates of the disease are continuing to rise. Much of the public continues to have limited understanding and knowledge of what syphilis is, how it’s spread, how to recognize it and what to do about it.
“We need to do a better job of letting the public know that syphilis is still around, how to recognize the signs and symptoms of the disease and that screening and treatment is available,” says Hamill.
In addition to better educating patients to be open and honest with healthcare providers about their sexual activity, healthcare providers need to learn how to speak with patients about STIs.
“People should feel empowered to ask their health care providers for tests that are usually covered by insurance,” says Hamill, “and clinicians should be comfortable asking patients about their sex lives.”
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What Is Syphilis? And Why Are Rates Rising? originally appeared on usnews.com
Update 09/17/24: This story was previously published at an earlier date and has been updated with new information.
