What Healthcare Providers Can Do
Syphilis Is Preventable and Treatable…And May Not Be On Your Radar
1 in 3 physicians have not received any post-medical school training in sexually transmitted diseases. And if knowing syphilis is knowing medicine, then too many providers now find themselves at a great disadvantage. If you have had limited, or no, experience with diagnosing and treating syphilis, do you know where to turn? Simply look to CDC’s STI Treatment Guidelines for recommendations and strategies that you can use to help prevent and treat this ancient disease.
The troubling reality is that when not adequately treated, syphilis can lead to visual impairment, hearing loss, stroke, and other neurological problems. Syphilis infection can also increase a person’s risk for getting HIV or giving it to others. As a provider, you need to be aware that all 50 states require that syphilis cases be reported to the state or local public health agency so that it can take action to find and treat exposed persons.
Syphilis Rates Are Increasing in Men, Women, and Newborns in the United States
Knowledge about the prevention and treatment of syphilis is especially important nowadays. Why? Because recent data show that syphilis rates are on the rise. Rates of primary and secondary (P&S) syphilis—the most infectious stages of the disease—increased a troubling 7% between 2019 and 2020.
While rates have increased among both men and women, men account for 81% of all P&S cases. Gay, bisexual, and other men who have sex with men (MSM) account for 43% of male cases with information on sex of sex partner.
Likewise, increases in congenital syphilis (CS) have paralleled the national increase in P&S syphilis among women of reproductive age. CS can cause miscarriage, stillbirth, early infant death, or severe illness in those infants who survive. Cases of CS increased by a staggering 235% between 2016 and 2020.
As a health care provider, you play an important role in reducing CS. Here’s what you can do:
- Complete a Sexual History for Your Patients. Have an honest and open talk with your patients about their sexual history. STD counseling should be provided to those at risk for STDs, and contraceptive counseling should be provided to those at risk of unintended pregnancy.
- Test All Pregnant Women for Syphilis. This should occur at the first prenatal visit or at the time pregnancy is confirmed. Repeat screening at 28 weeks, and at delivery, for pregnant women in areas of high prevalence and who are considered at high risk for syphilis during pregnancy (e.g., multiple sex partners, drug use, transactional sex, late entry into prenatal care or no prenatal care, meth or heroin use, incarceration themselves or of sex partners, unstable housing, or homelessness).
- Treat Women Infected with Syphilis Immediately. If a woman has syphilis or suspected syphilis, treat her immediately with long-acting penicillin G, especially if she is pregnant, according to CDC’s STI Treatment Guidelines. Test and treat the infected woman’s sex partner(s) to avoid reinfection. If you have challenges obtaining penicillin G, contact your state or local health department.
- Confirm Syphilis Testing at Delivery. Before discharging the mother or infant from the hospital, make sure the mother has been tested for syphilis at least once during pregnancy or at delivery. If she tests positive, manage the infant appropriately. All women who deliver a stillborn infant should be tested for syphilis.
- Quickly Report All Cases of Syphilis and CS. Report cases of syphilis by stage to the local or state health department right away; CS cases should be reported within 24 hours.
You also play an important role in reducing syphilis in MSM. Here are the actions you can take:
- Complete a Sexual History for Your Patients. Have an honest and open talk with your patients about their sexual history. Order CDC-recommended tests based on age, gender, sex or gender of sex partners, anatomic sites of exposure, and risk.
- Perform a syphilis test for sexually active MSM, including those with HIV infection, at least annually, and as frequently as every 3 to 6 months if there are multiple sex partners or substance use.
- Immediately Treat and Report Syphilis Cases. Stage and treat syphilis cases according to CDC’s STI Treatment Guidelines. Presumptively treat all MSM with signs or symptoms suggestive of primary or secondary syphilis and all MSM who are sexual contacts to a case of syphilis at the initial visit. If you have challenges obtaining penicillin G, contact your state or local health department. Report all syphilis cases by stage to your state or local health department.
For clinician resources, see Syphilis Treatment and Care.