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Syphilis is a highly treatable sexually transmitted infectious disease. However, rates of syphilis have greatly increased over the last several years. Physicians at The University of Kansas Health System point to the COVID-19 pandemic causing some breakdowns in the testing, prevention and treatment procedures for syphilis. Changes in sexual behavior and decreased access to healthcare also play a role. The result is that total cases of syphilis in the US increased 73% from 2017 to 2021, according to the CDC. Congenital syphilis, where the infection is passed to a fetus during pregnancy, increased by more than 200% in the same time.

What is syphilis?

Syphilis is caused by a bacterium. It is spread when someone comes into contact with syphilis sores. That contact can be person-to-person or by sharing needles, razors and other objects that have touched the sores. These sores can be on the genitals, vagina, anus, rectum, lips and mouth. Syphilis can also be passed from a pregnant person to a fetus.

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Types of syphilis

There are 4 stages of syphilis disease progression: primary, secondary, latent and tertiary. They each have different symptoms and risks. Congenital syphilis is the term used to describe a newborn who was infected with syphilis in utero.

Syphilis symptoms and risks

The primary stage of syphilis presents with a single sore or multiple painless sores. These are round and firm. They usually occur where you made contact with an infected person, often on the penis, vagina, anus, rectum, lips or mouth. These sores last 3 to 6 weeks. They will heal whether or not you get treatment. However, if you do not get treatment, you are still infected and can spread syphilis even without the sores being present. Additionally, you are more at risk for contracting other STIs, like chlamydia, gonorrhea and HIV, when you have syphilis.

Secondary syphilis involves a rash all over your body. The rash is rough and red or reddish-brown. It does not itch and may look faint. It can occur with sores or after your sores have healed. It can be on your hands and feet and may be accompanied by other symptoms like fever, headaches, fatigue, sore throat and more. Like in the primary stage, these symptoms will resolve without treatment. However, you will still have syphilis, the disease will continue to progress, and you may infect others. Additionally, you can develop ocular syphilis, which affects the eyes. Symptoms can range from conjunctivitis, or pink eye, to retinal detachment and blindness.

The latent stage of syphilis occurs when you have no physical signs or symptoms of the disease, but it is still within your body.

Untreated syphilis can progress to the tertiary stage. At this point, syphilis can have effects on your liver and brain. The inflammatory cells can infiltrate the heart and may lead to fibrosis. Over time this could cause aneurysms, myocarditis, stenosis and regurgitation of the heart, where blood that should flow outward comes back to the heart.

Congenital syphilis in newborns may present with a variety of symptoms including rash, jaundice, anemia or meningitis. While it is possible an infant infected with syphilis is born without symptoms, it is essential that they get treatment. Otherwise, there is a risk of developmental delays, seizures or even death. Mothers who are infected with syphilis should get treatment during pregnancy to avoid potential complications like miscarriage, low birth weight and premature birth.

Syphilis diagnosis and screening

Syphilis is diagnosed with a blood test and physical exam. This can be done by your primary care physician, OB-GYN, urologist or other care provider.

The CDC recommends all pregnant women get tested for syphilis whether they are at risk or not. In many places, this testing can be done at no cost to you.

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Syphilis treatment

Syphilis is treated with intramuscular injections of penicillin. Newborns with congenital syphilis may need to be treated in the neonatal ICU, but some could stay in a regular setting while getting penicillin.

Pregnant people who are diagnosed with syphilis will likely get extra ultrasounds to monitor the baby before delivery and may be referred to a maternal-fetal specialist.

Prevention is also incredibly important. Adopt safer sex practices, get tested proactively and start treatment as soon as possible to prevent the spread of syphilis.

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