Syphilis was close to elimination in 2000 and is now on the rise
Unsafe sex is the leading cause of the increase in cases
To win the fight against syphilis, we need to increase screening and detection among high-risk individuals from once a year to every three months.
That’s one of the recommendations announced today by the U.S. Preventive Services Task Force, an independent volunteer panel of experts that provides input about the effectiveness of specific preventive care services. The report appears in the Journal of the American Medical Association.
The increase in screenings should focus on the groups at highest risk – HIV-positive men, men who have sex with men, and men ages 20 to 29 – and safe sex practices, specifically the use of condoms, should be emphasized.
It’s a new strategy in a war America is currently losing. Syphilis increased 15% between 2013 and 2014, to almost 20,000 cases.
2000: Syphilis nearly eliminated
It was the dawn of a new century, and America was close to defeating syphilis, one of its most deadly sexually transmitted diseases. In 2000, there were only four cases of syphilis for every 100,000 people in the United States, and outbreaks were confined to a limited number of geographic areas and mostly persons of color. Then and now, black people are disproportionately affected in the United States.
Giddy with hope, the Centers for Disease Control and Prevention announced a national plan to eliminate the STD completely.
“There is currently a narrow window of opportunity to eliminate this disease while cases are still on the decline,” the CDC said in a 1999 executive summary of the plan. “Eliminating syphilis in the United States would be a landmark achievement.”
It didn’t happen that way.
“Now, in 2016, hopes for eradication have long since faded, as have many of the gains realized by the effort,” Drs. Meredith Clement and Charles Hicks wrote in the editorial “Syphilis on the Rise – What Went Wrong,” published in JAMA along with the task force recommendations.
“Rates of syphilis have trended steadily upward since 2000, and the CDC’s syphilis elimination efforts officially ended as of December 2013.”
What did go wrong? Clement and Hicks point to three factors: a decrease in public health funding over the past decade, more risky sexual behavior among men who have sex with men, and a focus on HIV prevention that took the emphasis off fighting other STDs.
The CDC’s budget, for example, lost more than a billion dollars a year during the past decade, at a time when the recession also blasted budgets of local and state health departments, where many STD programs reside.
At the same time, new and improved treatments for AIDS have contributed to longer and healthier lives, and to an increase in risky sexual behavior, as the fears of death from AIDS declines, Clement and Hicks added.
Syphilis still a deadly disease
Syphilis, historically called the “great pox,” starts with a single ulcer at the infection site near the genitals that is often overlooked by the patient. As it progresses, the genital sores spread, lymph nodes become painful, and ulcers begin to appear on the rest of the body.
When syphilis first appeared as a major outbreak, attacking the army of France’s King Charles VIII in 1495, the disease was much worse than it is today. A description from the time describes the ulcers as “large, painful and foul-smelling” sores that “could eat into bones and destroy the nose, lips and eyes.” The lesions often “extended into the mouth and throat and sometimes early death occurred.”
Today, if left untreated, syphilis can progress to late-stage disease in approximately 15% of cases, often accompanied by heart disease, as well as skin and bone lesions.
But even early stages are scary as the rash spreads across the body. In addition, an infection of the nervous system by the bacteria can happen at any stage. It’s called neurosyphilis and includes altered mental status, vision and hearing problems, tremors or weakness, and stroke from syphilis-induced meningitis.
A war we could win
The good news is that, if caught early, syphilis is an easily treatable disease. Penicillin works. But new cases of syphilis will be found only if doctors ask the right questions, and according to experts, that isn’t always happening.
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“Health care practitioners need to do a much better job of taking a sexual history and applying recommended screening approaches,” Clement and Hicks said. “Being reluctant or unwilling to ask about sexual behaviors is a disservice to the patient.”