EXECUTIVE SUMMARY
Reported cases and rates for primary and secondary syphilis are at their highest rates in 20 years, with incidence particularly severe among gay, bisexual, and other men who have sex with men (MSM). Infection rates also are rising among women, triggering a surge in congenital syphilis.
- Syphilis rates increased 27% among women from 2014 to 2015, resulting in a surge in the number and rate of infants born with congenital syphilis. In 2015, the number of congenital syphilis cases reached the highest level since 2001, data indicate.
- The latest data indicate MSM account for 82% of male cases in which the sex of the partner is known. The estimated primary and secondary syphilis rate among MSM is 309 cases per 100,000 people.
While syphilis elimination was in reach a decade ago, public health officials are now at a critical crossroads when it comes to syphilis prevention. Reported cases and rates for primary and secondary syphilis are at their highest rates in the past 20 years, with incidence particularly severe among gay, bisexual, and other men who have sex with men (MSM). Infection rates also are rising among women, triggering a surge in congenital syphilis.1
The CDC has received more reports of ocular syphilis in recent years, according to Gail Bolan, MD, director of CDC’s Division of STD Prevention, and Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. These numbers are a “clear reminder” that syphilis can strike many communities anytime and anywhere, the two said in a joint statement.
Concern for Women and Infants
According to the latest national statistics, syphilis rates increased 27% among women from 2014 to 2015, resulting in a surge in the number and rate of infants born with congenital syphilis. In 2015, the number of congenital syphilis cases reached the highest level since 2001, data indicate.1 (There was a report on this reported uptick in the January 2016 issue of Contraceptive Technology Update: http://bit.ly/2ojxfzW.)
The CDC’s current data show a 25% increase in syphilis among pregnant women from 2012-2014. About one in five women with syphilis were pregnant in 2014, the figures show. According to the CDC report, nearly half of all syphilis cases were among black pregnant women in 2014, with the largest increases among American Indians/Alaska Natives and whites.1
Babies infected with syphilis during pregnancy may exhibit developmental delays or experience other poor health outcomes; historically, as many as 40% of babies born to women with untreated syphilis may be stillborn or die from the infection, according to the CDC. The agency says treating pregnant women at least 30 days before delivery is 98% effective at preventing illness in infants.
MSM Hit Hardest by Syphilis
Gay, bisexual, and other MSM experience rates of syphilis not seen since before the dawn of the HIV epidemic. In 2015, this population made up most primary and secondary (P&S) syphilis cases, and data suggest that an average of 50% of MSM who contract syphilis also are infected with HIV.
The latest data indicate that MSM account for 82% of male cases in which the sex of the partner is known. The estimated P&S syphilis rate among MSM is 309 cases per 100,000, with rates varying by state, from 73.1 cases per 100,000 people in Alaska to 748.3 cases per 100,000 people in North Carolina.
What are the latest testing trends? The authors of a recent CDC analysis found a significant increase in syphilis screening in MSM, rising from 37% in 2008 to 49% in 2014, with low rates among those at high risk for the disease. Among those screened, the percentage who reported testing positive increased from 9% to 11%.3
Screening was most common among MSM at highest risk, including those living with HIV (68%), and those with more than 10 sexual partners in the past 12 months (65%). Data suggest that increases in diagnoses were greatest among MSM who were black (9-14%), living with HIV (15-21%), and those with 10 or more sexual partners (11-17%).3
To stem the increase, guidelines call for syphilis testing for all MSM at least once a year. Those at increased risk, such as those with a history of syphilis infection, incarceration, drug use, or multiple/concurrent partners, as well as those who live in areas with high rates of syphilis, should be tested every three to six months.2
Syphilis is a systemic sexually transmitted infection caused by the Treponema pallidum bacterium. One person passes it to another through direct contact with a syphilis sore or lesion, which occur primarily on the external genitals, vagina, anus, or in the rectum. These sores also can appear on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex.
According to the CDC, the time between syphilis infection and the start of symptoms can range from 10-90 days, with an average of 21 days. The first sign of syphilis is the appearance of a single sore — called a chancre — but there may be multiple sores. The chancre usually is small, round, firm, and painless, and appears at the spot where syphilis entered the body. This sore usually remains three to six weeks and will heal on its own. If the infection is not treated immediately, it moves into the secondary stage.
A patient in the secondary stage is highly infectious. Typically, rashes appear on the palms of hands, the soles of feet, or on the face. However, rashes also may appear on other areas of the body. For example, wart-like growths may form on the genital area. Generally, rashes and syphilitic warts tend to heal within two to six weeks, but may take as long as 12 weeks.
Experts say syphilis can be cured easily in its early stages. A 2.4 million-unit dose of long-acting Benzathine penicillin G administered intramuscularly will cure a person infected with primary, secondary, or early latent syphilis. The CDC advises administering three doses of long-acting Benzathine penicillin G at weekly intervals for individuals who present with late latent syphilis or latent syphilis of unknown duration.2 Although treatment kills the syphilis bacterium and prevents further damage, it will not repair damage already inflicted. Patients who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores heal completely. Clinicians should counsel patients with syphilis to notify their sex partners so that they can be tested and receive treatment if necessary.
How can you help patients reduce their risk of getting syphilis? While the CDC notes that the only way to avoid syphilis — or any sexually transmitted infection — is not to engage in vaginal, anal, or oral sex, there are steps to reduce risks.
If patients are sexually active, the following actions can lower syphilis transmission:
- Commit to a long-term, mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis.
- Use latex condoms properly every time. Remind patients that condoms prevent transmission of syphilis by preventing contact with a sore caused by the infection. Sometimes, these sores can occur in areas not covered by a condom, and contact with these sores still can transmit syphilis, according to the CDC.
REFERENCES
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016.
- Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3):1-137.
- Centers for Disease Control and Prevention. Gay & Bisexual Men Deserve The Best Health Possible. Fact sheet. Available at: http://bit.ly/2ob7nsm. Accessed April 18, 2017.
Experts say it’s time to act.
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