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Syphilis on the Rise: What You Need to Know

Jun 9, 2014
By Malcolm Thaler

The number of cases of syphilis in the US has reached its highest level since 1995, more than doubling in just the past 10 years. The vast majority of cases–over 90 percent–are occurring in men with same-sex partners, while infection rates in women are actually decreasing. Last year, over 16,000 cases were reported, but due to underreporting, this is probably an underestimate of the true size of the epidemic. A major cause of this increase is the declining use of condoms by people who are at risk.

This epidemic is troubling not only because the disease itself can be so devastating if left untreated, but because syphilis and the sexual behaviors associated with it increase the chances of acquiring and transmitting HIV–the co-infection rate is as high as 70 percent. And no, HIV preventive therapy with Truvada does not protect against syphilis.

Here are some important things you need to know about this STD:

How is syphilis contracted?

Syphilis is caused by a bacterium called Treponema pallidum. It enters the body through tiny abrasions, almost always during sexual intercourse. Rarely, it’s contracted by contact with other infectious lesions of the skin and mucous membranes, or in utero during delivery.

What is the course of the disease like?

Typically, the initial lesion is a sore called a chancre that appears at the site of inoculation approximately three weeks after infection. It can be large and dramatic or a small, barely noticeable papule. The chancre is painless and soon erodes to form a shallow ulcer. Some people develop multiple chancres. Chancres heal within several weeks, even without treatment, but the infection remains alive in the body and quickly spreads.

Within several weeks to months, if the initial lesion is untreated, a person may develop flu-like symptoms–headache, sore throat, muscle and joint aches, swollen lymph nodes, and a low-grade fever. A rash will typically develop, covering much of the mucous membranes and skin, particularly on the palms and soles of the feet.

Most people seek medical attention at this point, but if left untreated, the disease enters a long latent period during which there are no clinical signs or symptoms at all. Anywhere from one to as many as 30 years later, a person may enter late-stage syphilis, which can affect any organ in the body–potentially causing severe damage to the heart, aorta, and brain.

What’s the method of diagnosis and treatment options for syphilis?

There are several methods for diagnosis, but the most common is a blood test that screens for the infection.

Penicillin has been an effective treatment for syphilis at all stages without any signs of treponemes developing a resistance to it. The intensity and duration of treatment varies depending on the advancement of the disease. For patients allergic to penicillin, there are acceptable alternatives.

What’s the best mode of prevention for syphilis?

There is no vaccine for syphilis. The best way to prevent the disease is to follow safe sexual practices–most importantly, using condoms. Partners of an infected person who have been exposed within 90 days should be treated as if they have the disease, even if their blood tests are negative. And all infected people and their partners should also be tested for HIV infection.

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Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

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