Why syphilis is rising around the world

Since the earliest mention of syphilis in the 1490s, it has gone by various names, most of which are unflattering: “the French disease,” “the Neapolitan disease,” “the Polish disease.”

The phrase “the great imitator” has, however, endured. Syphilis is an expert at imitating other infections, and its early signs are simple to overlook. If unattended to, there may be severe repercussions.

Tushar, a 33-year-old project manager in Amsterdam, has experienced two cases of syphilis. He recalls initially getting the news via WhatsApp from his then-current sexual partner.

They were irate, he said. “They blamed me, which was incorrect given the window period. Being accused felt weird, and the situation took some time to diffuse. That week, Tushar received testing and treatment. “People incorrectly believe that syphilis cannot be treated. People are unaware of the implications of having syphilis antibodies but not the infection.

The United States’ most recent information on STIs was made public in April. The most significant increase was in syphilis cases, which increased by 32% between 2020 and 2021 to reach the highest reported rates in 70 years. The Centers for Disease Control and Prevention (CDC) stated that the outbreak also shows no signs of slowing down. The “alarming” new trends behind this abrupt increase in the disease have also been identified.

Congenital syphilis cases have grown dramatically, increasing by 32% in the US between 2020 and 2021. This condition occurs when a mother contracts the illness during pregnancy and passes it on to her unborn child. The condition may result in stillbirths, neonatal deaths, and chronic health issues.

Many health professionals are still in shock about it.

Leandro Mena, chief of the CDC’s division of sexually transmitted disease prevention, claims that “fifteen or twenty years ago, we thought we were on the verge of eliminating syphilis.” “There is no question that syphilis rates are rising, reaching levels we haven’t seen in about 20 years.”

The stigma of syphilis still stops many people from getting the necessary medical care. (Source: Alamy)

And it’s not only something that’s going on in the US. The World Health Organization estimates that 7.1 million new cases of syphilis will occur worldwide year 2020. Syphilis cases in the UK reached their highest level since 1948 in 2022.

Sexual health professionals on the front lines have become accustomed to the rise in instances.

“Primary syphilis was quite uncommon to see when I first started sexual health nursing in 2005, even in a city center clinic,” recalls Jodie Crossman, chair of the STI foundation in the UK, where syphilis rates increased by 8.4% between 2020 and 2021. “Nowadays, most city-based clinics will see at least two or three patients seeking treatment daily.”

The infection is brought on by the bacterium Treponema pallidum, which has four phases of symptoms. The initial stage is distinguished by a rash or a painless sore at the point of contact. Penicillin administered intramuscularly is considered the most efficient technique to treat the illness. However, if left untreated, syphilis can result in long-term cardiovascular and neurological conditions.

Isaac Bogoch, a researcher and clinician in infectious diseases at the University of Toronto, observes the epidemic as it develops in the US from across the border in Canada.

He claims that this is a worldwide trend that is being observed in many different nations. “It’s alarming because syphilis is typically very manageable and has an extensive range of treatment options. Therefore, most of this is indicative of a problem with public healthcare.

Compared to other STIs, infectious syphilis cases increased by 389% in Canada between 2011 and 2019.

Congenital syphilis cases have increased by 900% in Mississippi, according to medical professionals, during the past five years.

Most syphilis infections in recent years have been among gay, bisexual, and other males who have sex with other men. However, there are some regions of the world where fewer male instances of syphilis are being reported. For example, male cases of infectious syphilis declined in Canada. Congenital syphilis rates have increased in many parts of the world due to a spike in rates among women in Canada and globally. Health officials consider the 30,000 cases of mother-to-child transmissions of syphilis in the Americas as a whole to be “unacceptably high.”

Syphilis can be transmitted to an unborn child during pregnancy, which can have disastrous effects such as miscarriage, stillbirth, early births, low birth weights, and the death of a newborn soon after birth.

Congenital syphilis rates are skyrocketing in the US. They increased once more in 2021, resulting in 220 stillbirths and infant deaths, and were 3.5 times greater in 2020 than in 2016. Additionally, the national statistics seem to conceal sharp increases in some areas of the nation. For example, doctors in Mississippi have reported a 900% increase in congenital syphilis cases during the previous five years.

Black American women and Hispanic women have the most excellent rates.

“That does reflect the underlying inequity and racism we still have in our public health and medical infrastructure,” says Maria Sundaram, an associate research scientist at the Marshfield Clinic Research Institute in Wisconsin. The disease significantly impacts the most vulnerable female populations, including those who have lost their homes or battle addiction. And many of these disparities were made worse by the global Covid-19 outbreak.

Sundaram states, “The public health community has concluded that the increase in STIs, including syphilis, is probably due to a disruption of STI prevention resources during the pandemic.”

Access to STI testing facilities, the persistent stigma associated with syphilis, and potential language obstacles are a few of the disparities contributing to this issue. Black women with lower levels of education had more excellent rates of congenital syphilis, according to a Brazilian study. Women may have difficulty getting appropriate prenatal care, which includes syphilis screening.

Another study in Kern County, California—which in 2018 accounted for 17% of the state’s congenital syphilis cases despite having only 2.3% of the state’s population—found that pregnant women who sought prenatal care were more likely to be immigrants, have health insurance, or have experienced sexual or domestic violence. Interviewees who were expecting or just gave birth revealed that 50% of them were of Hispanic, Latino, or Spanish heritage.

Syphilis prevalence in Australia rose by nearly 90% from 2015 levels, according to a study published in 2020. In the Aboriginal and Torres Strait Islander groups, who make up barely 3.8% of the overall Australian population, almost 4,000 cases of syphilis were found. And although a nationwide test and treat response strategy was put into place to stabilize the epidemic, scientists say bringing levels back to pre-outbreak levels calls for much more extensive community testing. Once more, in some areas of the nation, there have been particular issues with pregnant mothers’ access to prenatal testing for syphilis.

Although the pandemic and the cost of living crises have impacted public healthcare resources, there have also been changes in how people behave and think about STIs.

“There was a big change in the mid-1990s with the advent of anti-retroviral therapy for HIV,” claims Mena. “Nowadays, HIV infection is regarded as a chronic illness because of improvements in HIV prevention and treatment. People are no longer motivated to use condoms or to take other STI preventive measures by the possibility of contracting HIV.

Researchers in Japan have been examining changes in sexual behavior by examining the correlation between the use of dating apps and syphilis incidence. They concluded that dating apps were “significantly associated with syphilis incidence,” connecting it to a rise in unprotected casual intercourse.

In her talks with sex workers, Sasaki Chiwawa, a writer on Japanese youth culture and the sex industry, also discovered this. According to Chiwawa, clients are not required to undergo STI testing, and an increasing number of sex workers are not wearing condoms. If sex workers get sick, they frequently blame “bad luck,” according to Chiwawa. “The majority of them prioritize financial gain over risk.”

Most health authorities believe that the best treatment for syphilis is still penicillin, despite the rate of antibiotic resistance rising. We already have the medications to treat it. More excellent public knowledge to promote safer sexual habits, more testing, and improved outreach to combat the disease’s stigma all have a far more significant role to play.

According to Crossman, “STI diagnoses shouldn’t carry any more stigma than getting a cold because we are social creatures.” “We are attempting to shift the focus of STI testing away from something terrifying and judgmental and toward something that is part of sexual wellbeing – an essential component of having a safe and enjoyable sex life.”

But scientists have yet to develop a single theory explaining why syphilis spreads more quickly than other STIs. According to Mena, little evidence supports the notion that the strains now in use have become more virulent. According to Bogoch, antibiotic resistance is not a widespread enough problem to account for the increases.

Tushar continues to undergo testing every three months.

We ought to be at ease discussing syphilis, he asserts. “So-called informed people make accusations rather than considering the situation scientifically. Things happen when we have sex.

Source: BBC