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Media Release 28 November 2001 

Facts on Syphilis

Syphilis Elimination - History in the Making

What is syphilis?

Syphilis is a bacterial, sexually transmitted disease (STD) that progresses in stages. The disease is curable and progression of disease is preventable, but if left untreated it can cause cardiovascular and neurological diseases, and blindness. Syphilis causes genital ulcers, which increase the likelihood of sexual HIV transmission two- to five-fold. Untreated, syphilis can be transmitted from a pregnant woman to her fetus.

How is syphilis spread?

Syphilis is passed from person to person through direct contact with a syphilis sore or lesion. These occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

Primary Stage

The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The average is 21 days. The primary stage of syphilis is usually marked by the appearance of a single sore – called a chancre – but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts from three to six weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage

The second stage starts when one or more areas of the skin break into a rash that usually does not itch. A rash can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rash is so faint that it is not noticed. Even without treatment, the rash clears up on its own. In addition to a rash, second-stage signs and symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.

Late or Tertiary Syphilis

The latent or hidden stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. The syphilis bacteria remain in the body and may begin to damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints, in up to one-third of untreated persons. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Can a newborn get syphilis?

Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without symptoms, but could develop them within a few weeks if not treated immediately. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.

In 2000, 529 cases of congenital syphilis – infants acquiring infection from their mothers during pregnancy or delivery – were reported. Rates of congenital syphilis closely follow trends in primary and secondary syphilis (P&S syphilis) in women, and peaks usually occur one year after peaks in P&S syphilis in women. The congenital syphilis rate in the United States peaked in 1991 at 107.3 cases per 100,000 live births and has since declined 88 percent to 13.4 cases per 100,000 live births in 2000.

How is syphilis diagnosed?

A health care provider can diagnose syphilis by using dark-field microscopy to examine material from syphilis sores. If syphilis bacteria are present in the sore, they will show up with a characteristic appearance.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate and inexpensive blood test. A low level of antibodies will stay in the blood for months or years, even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

How common is syphilis?

In 2000, 5,979 cases of P&S syphilis were reported to CDC, a decline of 9.6 percent from 1999 when 6,617 cases were reported. In 2000, 80 percent of the 3,135 counties in the United States reported no cases of P&S syphilis.

Syphilis continues to be concentrated in the southern region of the United States. In 2000, 21 counties and one independent city accounted for half of the total number of P&S syphilis cases reported. These counties were especially concentrated in the south, where the syphilis rate – 3.8 cases per 100,000 people – was higher than any other region in the country.

Since the introduction of penicillin and the organization of a national STD control program in the 1940s, the initial near elimination of syphilis in 1957 has been followed by cyclic national epidemics every seven to 10 years. The most recent epidemic peaked in 1990 at 20.3 cases per 100,000 people. Since 1990, P&S syphilis rates have declined 89 percent to 2.2 cases per 100,000 in 2000. In the United States, the reported rates of syphilis are at the lowest level since reporting began in 1941.P5/SR
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Does syphilis more commonly affect people by gender or race?

In 2000, the overall male-to-female rate-ratio of P&S syphilis was 1.5, with 50 percent more cases among men than women. Increases in the male-to-female rate ratio in 2000 were observed in certain cities, corresponding to an increase in syphilis among men who have sex with men (MSM). Recently, outbreaks of syphilis among MSM have been reported, possibly reflecting an increase in risk behavior in this population.

P&S syphilis rates in 2000 were highest among women ages 20- to 24-years-old and among men ages 25- to 29-years-old. However, the age groups at highest risk vary by race.

For all racial and ethnic groups, rates of P&S syphilis have declined since 1990, with the largest declines among African Americans. Despite these declines, syphilis continues to disproportionately affect African Americans and Hispanics. Syphilis has been cited as one of the most glaring examples of existing gaps in minority health status. Despite the fact that the disease can be easily treated and cured with basic medical care, reported rates of P&S syphilis in 2000 were 21 times higher for African Americans than for white Americans. Rates for Hispanics were three times higher than rates reported for white Americans. With increased awareness and access to acceptable health care, this health disparity could be largely eliminated.

In 2000, the rate of congenital syphilis among African Americans was 50.9 cases per 100,000 live births and among Latinos, 23.4 cases per 100,000 live births. These rates reflect a 12 percent decline for African Americans and a 13 percent increase for Latinos from 1999 to 2000, but they continue to remain considerably higher than the rate for white Americans, which was 1.5 cases per 100,000 live births in 2000.

What is the link between syphilis and HIV

While the health problems caused by syphilis in adults and newborns are serious in their own right, it is now known that the genital sores and increased HIV-target cells (CD4+ cells) caused by syphilis in adults make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of transmitting HIV infection when syphilis is present.

Is there a cure for syphilis?

Yes, a single dose of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to cure someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Penicillin treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. People who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. People with syphilis must notify their sex partners so that they also can be tested, and, if necessary, receive treatment.

Will syphilis recur?

Having had syphilis does not protect a person from getting it again. Antibodies are produced as a person reacts to the disease, and, after treatment, these antibodies may offer partial protection from getting infected again, if exposure occurs right away. Even though there may be a short period of protection, the antibody levels naturally decrease in the blood, and people become susceptible to syphilis infection again if they are sexually exposed to syphilis sores.

How can people protect themselves against infection?

The surest protection from sexually transmitted diseases, including syphilis, is to abstain from sexual intercourse or to have sex only in a mutually monogamous relationship with an uninfected partner. For others who are sexually active, male latex condoms, when used consistently and correctly, can reduce the risk of other sexually transmitted diseases, including syphilis. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Only lab tests can confirm whether someone has syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.

References:

W. Cates et al. Estimates of the Incidence and Prevalence of Sexually Transmitted Diseases in the United States. Sex Trans Dis 1999; 26 (suppl): S2-S7.

K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, chapters 33-37.

M.E. St. Louis and J.N. Wasserheit. Elimination of Syphilis in the United States. Science 1998;281:353-4.

Division of STD Prevention. Sexually Transmitted Disease Surveillance, 2000. U.S. Department of Health and Human Services, Atlanta: Centers for Disease Control and Prevention (CDC), September 2001.

 
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