CATES: Syphilis cases rising at alarming rates

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

I thought long and hard about if I should write about syphilis rates increasing because conversations about sexually transmitted diseases (STDs) can sometimes carry moral implications. I decided that I did need to write about this disease because regardless of the moral implications, syphilis is a medical issue. Treatment can only occur when people seek care, and that means talking about the possibility of an STD. I hope by talking about it here, someone will have the confidence to talk to a health care provider if they are concerned about syphilis or any other STD.

The current statistics for syphilis are very concerning. According to the Centers for Disease Control and Prevention (CDC), reported syphilis cases rose in the U.S. by 80% between 2018 and 2022. According to the Texas Department of State Health Services (TxDSHS), Texas syphilis cases rose by 22% between 2021 and 2022 and the 2022 rates are double of those from 2018.

The scariest part of these statistics is the increasing number of cases that are affecting pregnant women. Syphilis, if untreated during pregnancy, can be passed to the newborn and can be fatal. A syphilis infection in a newborn is called congenital syphilis. In 2021, TxDSHS reported the highest number of congenital syphilis cases ever recorded at 685. Preliminary 2022 data has shown another huge jump in congenital syphilis to 950 cases, a 39% increase in one year. In 2020, 220 stillbirths and infant deaths in the U.S. were related to congenital syphilis. According to the CDC, the risk of death for congenital syphilis is as high as 40%.

Syphilis is a very old disease. It is caused by the bacteria Treponema pallidum. Forms of that bacteria have been detected in human remains from 2000 years ago. It became a world-wide disease about 500 years ago, historians believe that spread was largely due to the abuses that accompany slavery. Because it is an STD, historically people have been reluctant to talk about syphilis. In the days before disease transmission was fully understood, it was frequently called a disease of a rival group or country as a way of saying culturally, “that is not our problem.” The Germans and English called it the French pox, Russians called it the Polish sickness, the French called it the Neapolitan sickness, the Japanese called it the Canton rash or the Chinese ulcer, just to name a few examples of that cultural distancing.

Many experts in disease transmission feel that people not wanting to talk about syphilis and the need to distance oneself from the disease is still an issue. That reluctance means people often do not seek treatment in early stages, and they spread the infection. Another contributor to the problem is that many people think that syphilis, because it is such an old disease, no longer exists, and don’t take preventative measures or discuss it with their sexual partner.

Syphilis has several stages that can last weeks to years. The first symptoms arise between 10 and 90 days after infection with an average of 21 days to first symptoms. Primary syphilis usually starts with a single sore, called a chancre, in, on, or around the penis, vagina, anus, rectum, lips or mouth. There is usually just one, but there can be multiple sores. Chancres are usually, firm, round, and painless and heal in 3-6 weeks with or without treatment.

Syphilis is spread by direct contact with a chancre. However, if the person does not receive treatment, syphilis will progress to the secondary stage. That stage includes skin rashes and/or mucous membrane lesions on one or more areas of the body. The rash usually does not cause itching. Other secondary stage symptoms include fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, muscle aches, weight loss and fatigue.

Just like with primary stage syphilis, the symptoms will resolve with or without treatment, but without treatment syphilis will progress to latent and possibly the tertiary stage. Latent syphilis has no signs or symptoms and can last for years. Tertiary syphilis is rare and can appear 10-30 years after infection and can be fatal. Tertiary syphilis can affect the brain, nervous system, eyes, heart, blood vessels, liver, bones, and joints. Symptoms depend on the organ system affected.

If you or your partner notice sores that could be chancres, or there is a chance you have been exposed to syphilis, seek medical attention with your primary health care provider. If you do not have a primary health care provider, the Ector County Health Department has expertise in all communicable diseases and can assist you in finding the right testing and treatment for syphilis and other STD’s.

The treatment for syphilis is most commonly a one-time shot containing penicillin. For someone with a penicillin allergy there are other antibiotic choices, but for pregnant women penicillin is the only option, so they may need to undergo penicillin desensitization to treat syphilis. Unfortunately, because of the rapid rise of syphilis cases we are also seeing a shortage of penicillin in the form needed for a shot.

As a final thought, please remember prevention, which is even more crucial with the penicillin shortage. The best prevention for syphilis is abstinence, followed by protected sex (using a condom). If you have syphilis or any other STD, do not have unprotected sex until you have been treated and have spoken about unprotected sex with a health care provider. Even if you are having protected sex, whether you have an STD or not, please discuss the possibility of STDs with your partner.