‘Alarming’ rise of syphilis reported in KY newborns and adults. We asked an expert why

Syphilis is making a concerning comeback across the country, with the U.S. Centers for Disease Control and Prevention reporting cases increased by nearly 80% between 2018 and 2022.

Kentucky isn’t exempt from that disturbing trend, warns Dr. Armaghan-e-Rehman Mansoor, an infectious disease specialist with UK HealthCare.

“There has been a marked increase in the rates of syphilis in the U.S. over the last few years. A similarly rapid increase is being seen in Kentucky, with the Kentucky Department for Public Health reporting a 77% increase in cases between 2020 and 2022,” Mansoor told the Herald-Leader in emailed comments Tuesday.

Even more troubling, the rate of congenital syphilis in the commonwealth is increasing at an “alarming” clip.

“Alarmingly, rates of syphilis in newborns in whom infections were transmitted in the uterus have risen by 169% just between 2020 and 2022,” Mansoor notes.

Syphilis, an infection caused by bacteria most commonly spread through vaginal, anal and oral sex, is not just another sexually transmitted disease. Many who have it may not recognize they do or the dangers of leaving it untreated.

“Syphilis is different from other sexually transmitted infections in that while most people notice early symptoms after infection, these symptoms can resolve on their own if left untreated. However, the syphilis bacteria can continue to multiply in the body and cause devastating complications months or even years later,” according to Mansoor.

So what’s driving this rapid increase? How can people protect themselves from infection or find out if they have it and get treatment? Here’s what to know.

How is it affecting the public?

A Jan. 30 surveillance report from the CDC tracked the rate of infection for syphilis (both all cases and congenital), gonorrhea and chlamydia between 2018 and 2022.

Out of the three, cases of syphilis showed the most dramatic rise, increasing steadily and rapidly from 113,739 cases in 2018 to 203,500 cases in 2022. That’s an increase of nearly 80%.

Nationwide, cases of congenital syphilis grew from 1,325 in 2018 to 3,755 in 2022.

A screen capture of a U.S. Centers for Disease Control and Prevention report monitoring rates for syphilis and other sexually transmitted infections between 2018 and 2022.
A screen capture of a U.S. Centers for Disease Control and Prevention report monitoring rates for syphilis and other sexually transmitted infections between 2018 and 2022.

“The most alarming concerns center around the syphilis and congenital syphilis epidemics, signaling an urgent need for swift innovation and collaboration from all [sexually transmitted infection] prevention partners,” the CDC said. “In addition to the syphilis epidemic worsening, reported gonorrhea cases declined for the first time in at least a decade while reported chlamydia cases were level.”

Factors behind rising rates of syphilis infections are complex and hard to isolate, according to Mansoor, ranging from the individual to systemic.

On the individual level, syphilis symptoms can be difficult to recognize and many may not seek timely care. Substance abuse disorder can also be a factor. Broader problems, including barriers to health care, also play a role, Mansoor told the Herald-Leader.

One thing is clear though: “The substantial rise in syphilis infection rates highlight the need for a coordinated response to this impending public health crisis. A cornerstone of this action is raising awareness within the public,” the specialist said.

What do people need to know to protect themselves?

Syphilis spreads through sexual contact (vaginal, anal or oral sex) and from a pregnant mother to her unborn baby. After infection, the disease progresses gradually in four stages. Each exhibits different signs and symptoms.

According to the CDC, each stage is described as follows:

  • Stage 1: Primary Stage - Individuals may notice a single sore or multiple where the infection entered the body. This can occur in, on or near the genitals, anus or rectum and lips or the mouth. The sores are usually, though not always, firm, round and painless. The sore usually lingers for three to six weeks and heals whether you receive treatment or not. If the sores have gone away, you should still seek treatment, because it will stop the disease from advancing to the more problematic stages.

  • Stage 2: Secondary Stage - In this stage, symptoms could include rashes or sores in the mouth, vagina or anus. The stage usually starts with a rash on one or more areas of your body. This rash can be on the palms of your hands or the bottom of your feet and look rough, red or reddish brown. The rash usually doesn’t itch and is sometimes so faint, you won’t notice it. It typically occurs two to six weeks after the initial sore. Other symptoms during this period include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue. The symptoms from this stage will go away without treatment, but the disease will continue to progress.

  • Stage 3: Latent Stage - During this phase, the infection seems to go dormant and there are no visible signs or symptoms. Without treatment, the infection can linger in your body for years, causing significant problems later.

  • Stage 4: Tertiary Stage - Most people with untreated syphilis do not develop tertiary syphilis, but when it does happen, many different organ systems are affected. These include the heart, blood vessels, brain and nervous system. This stage occurs 10 to 30 years after infection and damages internal organs, possibly causing death.

Without treatment, syphilis can spread to the brain, eye or ear, and in some severe cases, cause dementia, blindness or hearing loss.

“It is imperative that if individuals are interested in screening, or see symptoms of early infection such as a new rash, ulcers in the genital or oral area, genital pain, irritation or drainage, that they know to seek care,” Mansoor told the Herald-Leader.

“Diagnosis is easily done with blood tests, and treatment, if diagnosed in a timely manner, is well tolerated and uncomplicated. Testing can be obtained at primary care offices, health department sites, student health at University campuses and from Infectious Diseases providers,” Mansoor said.

The specialist added that prophylactics, such as Doxy PEP and PREP, can reduce exposure risk to syphilis and other STIs.

According to the Lexington Fayette-County Health Department, it’s important to keep the following points in mind.

  • Syphilis is a treatable condition. According to the CDC, one injection of long-acting penicillin can cure the early stages of the disease. Treatment cures the infection and prevents further damage, which is why it’s important to detect the infection early. That can be done by a blood test from your doctor.

  • People can also be reinfected with syphilis if they do not practice safe sex. Those strategies include abstaining from sex, reducing your number of sexual partners, practicing mutual monogamy and using condoms for oral, anal and vaginal sex.

  • Syphilis is not routinely tested for. Ask your doctor or health care provider to test for syphilis along with HIV, chlamydia and gonorrhea.

  • Those who are pregnant should seek prenatal care early and for the full term of their pregnancy. Testing and treatment for syphilis can help protect the infant.

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