Explainer: Rising cases of syphilis in the US: What is this stigmatised disease all about?

Reports in CNN are all rife about a syphilis outbreak as informed by the Houston Health Department, this Thursday, with an increase of 128% among women in the city, and a ninefold increase in congenital cases in Houston and the surrounding Harris County area since 2019.

While we can see that it is making inroads into the US, this is actually something that needs to be noted and prevented, all over the world. The department said that new infections rose by 57% from 2019 to 2022. There were 2,905 new infections in 2022, compared to 1,845 new infections in 2019. 

There were 674 cases among women in 2022, a steep increase from 295 cases in 2019, according to the release. And there were 151 cases of congenital syphilis in 2021, the latest year for which statistics are available, compared to just 16 cases in 2016.

It is all the more worrying when it comes to congenital syphilis which happens when a mother passes the bacterial infection to the baby in the womb. Untreated congenital syphilis can lead to stillbirth or damage to the baby’s organs or bones. Considered the highest risk category, pregnant women should be tested frequently. 

Known as a bacterial infection that is commonly spread through sexual contact, it usually starts with a painless sore on the genitals or mouth – direct contact with the sores spreads the infection. As detailed by the Mayo Clinic, after the initial infection, the syphilis bacteria can remain inactive in the body for decades before becoming active again.

Syphilis spreads from person to person via skin or mucous membrane contact with these sores. Early syphilis can be cured, sometimes with a single shot (injection) of penicillin. The cause of syphilis is a bacterium called Treponema pallidum. The most common way syphilis is spread is through contact with an infected person's sore during sexual activity. The bacteria enter the body through minor cuts or abrasions in the skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.

Less commonly, syphilis may spread through direct contact with an active lesion, such as during kissing. It can also be passed from mothers to their babies during pregnancy or childbirth.

In the early stages, because it may not have obvious symptoms, pregnant people and their healthcare providers might not notice it or screen for it at all.
It starts as painless sores  or chancre that spreads the disease that can go undetected as they do not hurt. Primary syphilitic chancres are usually firm, round, small, and painless.

According to the US CDC, the sores will last 3-6 weeks regardless of treatment, but it’s very important to seek medical care nevertheless to prevent the infection from progressing to the next, more dangerous stage. 

Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don't always occur in the same order. You may be infected with syphilis without noticing any kind of symptoms for years.

If detected early, syphilis can be treated with antibiotics. It can also lie dormant in the body without treatmentfor years or even decades before it affects the brain, nerves, eyes, and other organs. It can also cause deafness, blindness, and death.

Other issues may occur like headache, stroke, meningitis, hearing loss, visual problems, including blindness, dementia, loss of pain and temperature sensations, sexual dysfunction in men, bladder incontinence, cardiovascular problems. There could be bulging and swelling of the aorta — your body's major artery — and of other blood vessels. It may also damage heart valves.

How to avoid syphilis

Contrary to popular perception and according to the US CDC, syphilis cannot be spread through toilet seats, door knobs, or even from sharing utensils. The only way to avoid syphilis is by avoiding contact with the sores. One should use condoms if one is sexually active. However, it is important to note that contact with the sores in areas not covered by a condom can also spread the disease.

If a child experiences any unusual discharge, sore or rash — particularly if it is in the groin area, then one has to be cautious and take the child for a checkup.

Once cured, syphilis doesn't return on its own. However, you can become reinfected if you have contact with someone's syphilis sore. The biggest risks are having unprotected sex or with multiple partners, or if one is infected with HIV, the virus that causes AIDS. Treatment can help prevent future damage but can't repair damage already done.

History of the dreaded disease

History goes back to the Columbian Hypothesis, which states that Columbus’ seamen, who arrived in the Americas in 1492, brought the disease back to Europe following exploration of the Americas. This timing correlates with the first reported outbreaks among the French troops in Europe during the War of Naples in 1495. But there is also evidence that says syphilis was already present in the New World at the time of Columbus’ arrival. There is also new information  observed through carbon dating and examination of bone pathology that talks about syphilis occurring and spreading worldwide. There are many theories that are afloat about its origin.