• Posted April 29, 2024

Syphilis Is Increasingly Displaying Atypical, Severe Symptoms

Syphilis cases are on the rise in the United States, and doctors in Chicago say they are increasingly seeing cases that don't display typical symptoms, such as rash or skin ulcers.

Instead, patients are presenting with headaches or disruptions in their vision or hearing, said a team co-led by Dr. Amy Nham. She's a first year epidemic intelligence service officer assigned to the Chicago Department of Public Health.

Her new report was presented last week at the 2024 Epidemic Intelligence Service Conference in Atlanta.

Nham and two co-authors gave an overview of these "neurologic, ocular, and otic (NOO)" -- affecting the brain, eyes and/or hearing -- forms of syphilis, which can often be severe.

The team found 36 potential NOO syphilis cases in the Chicago area, reported between January and August of 2023.

Twenty involved a brain-targeted neurosyphilis, 17 were syphilis affecting the eyes, and one case involved hearing.

Men were most likely to be affected, with more than half identifying as heterosexual, the team said.

NOO syphilis has traditionally most often been seen among HIV-positive people, but in the Chicago cases two-thirds of those affected were not infected with HIV.

"Signs or symptoms consistent with NOO syphilis were often the only presentation" symptom, the researchers noted. "Clinicians should consider NOO syphilis even in persons presenting without typical syphilis signs and symptoms and persons without HIV."

Speaking with CNN, Nham said that "providers definitely need to be screening more and be aware that this is what we're seeing."

"They're not the most specific symptoms, which is why it's really important that providers are doing appropriate screening and asking patients for risk factors," including a patient's sexual history, Nham added.

Syphilis is a common sexually transmitted infection caused by the Treponema pallidum bacterium. It is typically spread through contact with syphilis sores during vaginal, anal or oral sex, according to the U.S. Centers for Disease Control and Prevention.

Typically -- but, as Nham team's pointed out, not always -- sores called chancres appear around the vagina, penis, anus, lips or mouth during the first stage of syphilis. The sores are often painless, but people should seek diagnosis and treatment as soon as they arise. Rashes often appear in the disease's second stage.

Syphilis can also be latent, however, entering a stage where it can silently infiltrate the brain, the nervous system and the eyes and/or ears. Headache, confusion, muscle weakness, and vision and hearing issues can also emerge, the CDC said.

The good news: Syphilis is easily curable with antibiotics. But early detection and treatment is key.

According to 2022 numbers from the CDC, more than 202,000 cases of syphilis were recorded among Americans that year -- a 17% rise over 2021 and an 80% rise over numbers recorded in 2018.

Syphilis can also be passed from a mother to her baby, and infection in a newborn can lead to a myriad of health issues such as heart and brain damage, blindness, deafness and paralysis. When transmitted during pregnancy, it can also cause miscarriage, lifelong health problems and infant death.

Cases of infant syphilis have been soaring recently in the United States. Earlier this month, the American College of Obstetricians and Gynecologists (ACOG) urged syphilis screening for all pregnant women.

More than 10,000 women who gave birth in 2022 had syphilis, up from about 3,400 cases in 2016, according to recent CDC numbers.

The ACOG advisory paints an even more dire picture, saying that U.S. rates of babies born infected with syphilis had increased by 755% between 2012 and 2021.

"There has been a near eightfold increase in congenital syphilis cases in the last decade or more, and from a public health perspective, we recognize that obstetrician"“gynecologists and other obstetric care clinicians play a critical role,"said Dr. Christopher Zahn, ACOG's interim CEO and chief of clinical practice and health equity and quality.

More information

Find out more about syphilis at the Mayo Clinic.

SOURCES: Epidemic Intelligence Service Conference, abstract, April 24, 2024; American College of Obstetricians and Gynecologists, news release, April 18, 2024; CNN; Sexually Transmitted Infections Surveillance, Jan. 30, 2024