Before antibiotics, syphilis was the most feared sexually transmitted disease (STD) out there. It was easy to get, quack cures were ineffective and often unpleasant, and it could lead to blindness, disfigurement, dementia, or even death. When we were finally able to zap infections away with drugs like penicillin, it seemed like we’d finally won the battle against this scourge. Whereas syphilis rates were highest before antibiotics became widespread in the 1940s, by 2000 we saw a low of 2.1 cases of syphilis per 100,000. At the dawn of the new millennium, many scientists thought the United States was at the dawn of the complete elimination of syphilis.
Using condoms, regular STD testing, and limiting sex partners are the best ways for sexually active people to stay healthy.
Must all good things come to an end? They shouldn’t have to, but in the case of syphilis, the Centers for Disease Control and Prevention (CDC) has announced that syphilis rates are rising, with incidence doubling since 2005. In the United States, there are now 5.3 cases of syphilis per 100,000 people, but that number is a bit misleading because it represents an average across the general population. When you break the population down by age, race or ethnicity, gender, or sexual orientation, that rate might be much higher or much lower. For example, syphilis rates are actually on the decline among women (at only 0.9 cases per 100,000), but among men it is 9.8 per 100,000. In fact, most new syphilis cases — 91.1 percent of them, to be precise — are in men, most of whom are gay or bisexual.
Syphilis is rising the most dramatically among men in their twenties, especially among men who have sex with men (MSM). While some wonder if syphilis is growing among twenty-somethings because this group didn’t live through the early era of AIDS, when HIV was seen as a death sentence and safer sex practices were more common, it might also be due to the fact that STD rates are higher among young people in general.
Interestingly, 2013 marked the first year in at least half a century that syphilis rates weren’t highest in the South. Now they are highest in the West (a region the includes all U.S. states west of, and including, Montana, Wyoming, Colorado, and New Mexico), at 6.5 cases per 100,000 among the general population. For example, in Alaska, public health officials report a syphilis outbreak centered in Anchorage, and have found that most new cases of syphilis occur among MSM. Most of those infected reported finding sexual partners online, highlighting how important it is to use condoms correctly and consistently when having sex with a partner whose STD status is unknown to you. Other ways to reduce risk include being in a mutually monogamous relationship in which both partners are free of STDs.
Here in Arizona, syphilis rates mirror nationwide trends. Pima County, for example, recorded 31 cases of syphilis in 2012 and 55 cases in 2013. As of July 23, however, Pima County has already recorded 73 cases of syphilis in 2014, and 70 of those cases were in male patients. Paralleling national trends, Arizona’s MSM population is most affected by the current syphilis outbreak — 93 percent of newly diagnosed males identify as MSM. Also echoing nationwide trends is the use of new technologies to find sex partners: 57 percent of new syphilis cases in Pima County reported finding partners using the Internet and smartphone apps.*
The phenomenon of using smartphone apps and the Internet to find sexual partners is getting a lot of attention in connection to the current increase in syphilis rates — although one study found no correlation with increased syphilis rates, only to increased rates of gonorrhea and chlamydia. These tools make it easier to find anonymous partners, and a reduced fear of HIV, compared to years past, means that today, MSM may be less likely to use condoms and engage in other protective behaviors. There is also a stigma around syphilis testing, whereas HIV testing has been normalized in the LGBTQ community.
Another reason the rise in syphilis cases is alarming is because syphilis infections make it easier for HIV to get into your body. Syphilis can cause open sores, through which the virus that causes AIDS can more easily pass. When someone with a syphilis infection is exposed to HIV, they are two to five times more likely to be infected with HIV. Furthermore, someone with both syphilis and HIV is more likely to transmit HIV to others, because syphilis causes a higher viral load. An estimated 50 to 70 percent of MSM who are in the primary or secondary stages of syphilis are also infected with HIV.
Men who have sex with men are not the only people who need to be worried about syphilis. Although it is relatively rare in the female population, women are still vulnerable. When pregnant people have syphilis, their babies are at risk for complications caused by congenital syphilis (the transmission of syphilis from mother to infant), such as blindness and deafness. Syphilis during pregnancy also increases risk for stillbirth, preterm birth, and low birth weight. For these reasons, it’s very important to receive testing and treatment for STDs during pregnancy. Here in Arizona, a 2010 outbreak gave us one of the highest rates of congenital syphilis in the country. At the time, the outbreak was most common among heterosexuals of reproductive age. Luckily, that outbreak is behind us. For example, in Pima County, the second-most populous county in the state, there haven’t been any cases of congenital syphilis so far this year.*
Gay or bisexual men who have had multiple or anonymous sexual partners are encouraged to be screened for syphilis every 3 to 6 months. The CDC also recommends testing for people who have had unprotected sex, those who have had multiple partners, pregnant people, and anyone whose partners have tested positive for syphilis, among others. You can get tested for syphilis and other STDs at a Planned Parenthood health center. It’s important to catch syphilis in its early stages, as any damage it does to your body is irreversible.
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* Correction, July 28, 2014: An earlier version of this article gave the impression that congenital syphilis rates in Arizona were still among the highest in the nation. It has been edited to reflect current syphilis trends in Arizona, as verified with a representative from the Pima County Health Department.