Syphilis cases in the United States increased by 80% between 2018 and 2022. This is a sexually transmitted infection that was nearly eradicated in the 1990s. Rates increased throughout the country in all age groups. Besides sexually active adults, newborn babies of infected mothers are at high risk. There was a 937% increase in the past decade in infant cases. Babies can acquire infection during pregnancy, childbirth and breastfeeding. In 2022, there were over 207,000 cases of syphilis.
Massachusetts required a blood test prior to marriage for syphilis starting in 1943. Syphilis was a public health concern with no effective treatment as soldiers were going off to World War II after hasty marriages. The government was concerned they would get syphilis after a quick marriage and be too ill to fight. This was based on the incorrect assumption that people didn’t have sex until they got married.
This requirement continued for decades, despite near eradication due to testing and antibiotics. In 2005, with a total of 100 syphilis cases in the state, it was repealed. Officials determined there were so few cases detected in engaged couples, this requirement was outdated and costly for the state and the couples. It was also realized that screening a low-risk group of people choosing to be monogamous wasn’t highly effective.
Inequities in health care, increase in substance abuse tied to risky sexual behavior, decrease in condom use, social and economic issues and a reduction in available services are blamed for the rise in cases. States lost funding for sexually transmitted disease prevention last year. Given these alarming increases, the CDC is looking at public health strategies to mitigate this very serious infection.
It is important to note that data and care of sexually transmitted diseases were skewed through the pandemic. So much focus was on COVID-19, other diseases were put on the back burner.
Syphilis presents in adults in three stages. The first stage is a painless sore in the mouth, rectum or genitals. Second stage is a rash. The final stage, which could be years later, results in damage to the brain, nerves, eyes and heart. It can cause blindness, deafness and paralysis There are many other symptoms, such as fever, fatigue, sore throat, hair loss, weight loss, swollen glands, headache and muscle pains. Cases in pregnancy cause miscarriage, infant death and lifelong medical problems.
Early syphilis can be cured sometimes with a shot of penicillin. Thus, screening and early diagnosis is crucial. New treatments and testing are being researched. Doxycycline is being used as a post-exposure treatment after unprotected sex to prevent syphilis and other STDs.
Syphilis is preventable and curable. History has shown a syphilis public health epidemic can be controlled. Collaboration of health care providers, state and local health departments to improve access to care and disease management is the key. Federally, a syphilis task force has been established.
Syphilis is one of many sexually transmitted diseases considered to be an epidemic. Strategies other than premarital testing are needed to return to near eradication, save lives and disabilities.
Take care of yourself and someone else.
Westfield Health Department staff and Board of Health members Juanita Carnes, FNP-BC, Carrie Hildreth-Fiordalice, LICSW, and Stan Strzempko, M.D., are dedicated to protecting the public health of this community and keeping you safe.
