Syphilis situation: Surge of preventable, curable but persistent disease

Stephen Thacker, M.D., sees the impact of a surge in syphilis cases on its youngest victims: babies born to mothers who unwittingly passed on what’s normally a sexually transmitted disease.

“Most infants don't have symptoms when they're born. It’s why we have to be very vigilant about how we test mothers and recognize at-risk infants, so that we can get that curative treatment in before they have lasting harm from this infection.” 

 

Thacker, an infectious disease specialist at MUSC Children’s Health, hates to see syphilis make a comeback. “Syphilis rates are higher than they've been in quite some time. The sobering thing for me about this topic is that there was a moment in the late ‘90s, early 2000s, where we were optimistic we could eliminate syphilis from most of our communities in the U.S. Then the wheels fell off, and we have been trying to stem the tide ever since.”

But Thacker said stemming that tide is doable. “Given our success in reducing syphilis in the past, we know there is a path forward to change this trend. It will require improved access to testing and treatment and improved education of providers and our communities. Unfortunately, we continue to see rises in many of our sexually transmitted infections across the U.S. and particularly the Southeast.”

Thacker, an associate professor in the College of Medicine at the Medical University of South Carolina, said syphilis is gaining more visibility in part because of its increasing impact on babies. “When you compare where we were in 2012 with diagnosed congenital syphilis, the rate of increase to where we were in 2021, it's an increase of over 750%.”

Congenital means babies are born with the disease. The numbers aren’t huge – they went from about 300 babies in 2012 to about 3,000 in 2021 – but they are concerning, because many could have been prevented, Thacker said.

In babies, early symptoms can include what Thacker called “a pretty impressive rash” that would lead to a doctor’s visit. In adults, there’s often a painless ulcer around the site of sexual contact. Whatever the presentation, penicillin is the cure.

 

If people don’t get that penicillin, they can develop secondary syphilis. “This is where folks usually see a doctor. It can cause fevers, it can cause new skin lesions and rashes, new ulcers inside of related to our genitalia and hepatitis,” Thacker said.

If they don’t see a doctor at that point, Thacker said the disease goes into a new phase. “About 60% of people will never have symptoms again, but 40% will develop complications later in life, which can cause neurologic changes. That means harm to the brain that can cause meningitis, hearing and vision loss, or decrease cognitive function. It can also affect how the heart functions and lead to soft tissue injury, meaning we've got these masses that develop in the body.”

That’s why it’s important to catch syphilis early, he said. With that in mind, MUSC Children’s Health is working with other health care leaders to try to prevent new syphilis cases in babies. 

“There's a multidisciplinary collaborative, which includes some obstetricians and infectious disease specialists from MUSC, and experts from other community sites. We work with leaders in the regional Department of Public Health to review all cases of congenital syphilis in our region of the Lowcountry,” Thacker said. 

The team looks at how mothers and babies were cared for, trying to determine how things could have gone differently. “Where was our opportunity to do better the next time around? And so that work group meets to review all of these cases. We’ve provided messaging and education to our partners who deliver babies as well as pediatricians and family medicine doctors that care for newborn babies to highlight syphilis rates in our state.”

In South Carolina, it’s recommended that pregnant women get screened in the first and third trimesters for infections such as syphilis and HIV. If they test positive, they can get treatment. Untreated syphilis puts babies at risk of serious complications, including death.

Thacker encouraged everyone at risk to play it safe. “The best way to protect yourself is to use barrier protection if you’re sexually active and get tested and screened. Part of being a healthy human in this world is being screened for sexually transmitted infections. And certainly, when it comes to unprotected sex with new partners, that's just part of being healthy.”