Syphilis is surging

February 21, 2024 Swedish Health Team

[5 min read]

In this article: 

  • According to the CDC, Syphilis cases are at their highest rate in almost 75 years. The number of cases rose over 500% between 2020 and 2022. 
  • Syphilis is spread via person-to-person contact. The infection can be transmitted from a pregnant person to their unborn child. Up to 40% of untreated syphilis cases among pregnant people result in infant death. 
  • Screenings, safe sex, and choosing health-aware partners can mitigate your risk. 

The U.S. Centers for Disease Control and Prevention (CDC) reported in late January that syphilis, which was once nearly eliminated in the United States, is currently reaching a number of infections unseen in America since the 1950’s. 

Syphilis is a highly contagious sexually transmitted infection (STI) that can have severe consequences if left untreated. While syphilis is primarily spread through sexual contact, it can also be transmitted by skin-to-skin contact with an active sore or rash.

According to the CDC, more than 207,000 cases were diagnosed in 2022, representing an 80 percent increase since 2018 and a 17 percent increase since 2021. The agency noted that syphilis is increasing among all age groups, including newborns and caused 231 stillbirths and 51 infant deaths in 2022. 

To learn more, we spoke with Kevin Wang, M.D. Dr. Wang is the medical director of Swedish Health Services’ LGBTQ+ Program and has a background in family medicine. He sees patients at Swedish’s Family Medicine Residency Clinic in First Hill.

“Syphilis is a bacterial infection caused by the spirochete Treponema pallidum. It primarily spreads through sexual contact, including vaginal, anal, and oral sex. However, it can also be transmitted through skin-to-skin contact with an active syphilis sore or rash. It is a highly contagious infection with multiple stages and can manifest in various ways,” say Dr. Wang.  

“Initial or early infection with syphilis usually shows up as a bump on the skin which is usually painless and becomes an ulcer 1-2 centimeters in size.  Patients may also notice some small lymph nodes in the groin.  These skin lesions, known as chancres, usually show up on the genitals but may also show up where the infection occurs including the throat, anus, and vagina.  These chancres heal within 3-6 weeks even if someone doesn’t get treatment. If someone doesn’t know they were infected, about a quarter of people may get other vague symptoms including fever, headache, sore throat, muscle aches, swollen lymph nodes, rash (may show up differently in each person), hair loss, vision changes, or hearing changes. If infection lasts for a much longer time, patients may develop heart and neurologic complications. These symptoms may be interrupted with periods of having no symptoms at all. Syphilis can be tricky to diagnose and having open conversations with clinicians can help us offer appropriate screening.”

Protecting yourself from syphilis

  • Practice safe sex. Using condoms consistently and correctly is one of the most effective ways to prevent syphilis transmission. Condoms act as a barrier that helps reduce the risk of exposure to syphilis sores or rashes.

“Although the incidence of syphilis is higher in cisgender gay men, there's an increasing number of cisgender heterosexual (as far as we know as people may also be exploring their sexualities or not share who they have sex with) people who are diagnosed with syphilis,” adds Dr. Wang

  • Get tested regularly. Regardless or orientation or gender identity, regular sexual health screenings, including syphilis tests, are crucial for early detection and timely treatment. It is recommended that sexually active individuals get tested at least once a year—or more frequently if engaging in high-risk behaviors.

“Screenings and sexual health visits with your practitioner should be a regular part of your health-care and self-care,” says Dr. Wang. “In general, practitioners often recommended screening to men who have sex with men (MSM), whatever their sexual orientation, more frequently than other populations. Although the MSM community makes up for the majority of syphilis cases, screening among this population occurs more frequently in part due to a higher update of preexposure prophylaxis (PrEP), which lowers the risk of acquiring HIV, and doxycycline postexposure prophylaxis (doxyPEP), which is used to help reduce the risk of acquiring an STI and used as PrEP.

  • Choose health-aware partners. Having fewer partners reduces the risk of exposure to syphilis or other STIs. Choosing partners who have been tested and are aware of their sexual health status is a responsible approach towards minimizing the spread of syphilis.
  • Educate yourself. Syphilis is often misunderstood and stigmatized, which can lead to delayed diagnosis and treatment. By educating yourself about the symptoms, risks, and available treatment options, you can make informed decisions and help eliminate misconceptions surrounding syphilis.
  • Avoid drug and alcohol abuse. Substance abuse can influence judgment and lead to risky sexual behaviors. Engaging in condomless sex while under the influence increases the likelihood of syphilis transmission. By prioritizing your overall well-being, you can reduce the chances of contracting or spreading the infection.

Syphilis and pregnancy

One alarming aspect of syphilis is its ability to be transmitted from an infected mother or birthing parent to the newborn. Known as congenital syphilis, this transmission can occur at any stage of pregnancy and result in serious health complications for the infant. During pregnancy, the bacterium can cross the placenta and infect the fetus, leading to premature birth, low birth weight, and even stillbirth. Infected babies may also develop congenital syphilis symptoms, including bone deformities, rashes, fever, anemia, and neurologic issues.

In the United States, cases of congenital syphilis rose by 32% resulting in over 200 stillbirths and infant deaths. In King County, 11 cases of congenital syphilis were found which is a 10-fold increase compared with 2020. 

To protect the health of both mother/birthing parent and child, regular prenatal care is crucial. Pregnant individuals should undergo routine syphilis screening during their first prenatal visit and repeat tests throughout pregnancy if they are at high risk or live in areas with high syphilis rates. Treating syphilis with antibiotics during pregnancy is essential to prevent the transmission of the infection to the fetus. Penicillin is the recommended antibiotic, as it is highly effective in treating and preventing further complications associated with syphilis. There are ways to still treat if the parent is allergic to penicillin!

The surge in syphilis cases emphasizes the need for increased awareness, education, and safe sexual behavior. By understanding the modes of transmission and implementing preventive measures, such as practicing safe sex, getting tested regularly, and avoiding risky behaviors, individuals can protect themselves and their partners. Additionally, pregnant patients should prioritize prenatal care and undergo syphilis screenings to ensure the health and well-being of both themselves and their infants.

Understand your risk. Talk to your provider.

“Knowledge is power when it comes to combating syphilis and other STIs,” says Dr. Wang. “Having honest conversations about your health and risk factors can help ensure every patient gets the right screening, evaluation, and treatment.”

“If you suspect that you might have a syphilis infection, be sure to see your clinician — preferably your primary care provider,” says Dr. Wang. “You can get screened and learn more about treatment and how to protect yourself.” 

Learn more and find a practitioner 

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your clinician to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you. 

If you have questions about LGBTQIA+-informed care, contact LGBTQIA+ Care or Transgender Health at Swedish. We can accommodate both in-person and virtual visits.

Information for patients and visitors 

Additional information

CDC STI fact sheet

Syphilis epidemic - King County, Washington

The best time to find a primary care practitioner is when you don’t need one

Investing in access to holistic health care for our LGBTQIA+ communities

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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