Rising Cases of Syphilis with Uncommon and Severe Manifestations, Research Reveals
Health experts in urban centers are noting a concerning pattern: individuals presenting with atypical signs such as vision disturbances, headaches, and hearing impairments attributed to syphilis, a sexually transmitted disease.
In Chicago, disease detectives have noticed a concerning trend: patients are reporting unusual symptoms such as vision and eye problems, headaches, and hearing loss or dizziness, all caused by the sexually transmitted infection syphilis.
It has been well-established by doctors that syphilis can cause permanent damage to a person's vision and hearing, and can even result in psychiatric changes. These symptoms are typically seen in cases where the infection has been left undiagnosed and untreated for a long period of time.
Researchers presented a new study at the 2024 Epidemic Intelligence Service Conference in Atlanta. The study revealed that in Chicago last year, there were over twenty cases with similar symptoms. Interestingly, almost one-third of these cases were in the early stages of their infections.
Darkfield micrograph of Treponema pallidum.
Darkfield micrograph of Treponema pallidum.
CDC
Related article
As syphilis cases continue to surge in the US, recent federal efforts aim to tackle the alarming trend
In a recent study, it was found that 68% of patients with syphilis did not show typical symptoms such as a rash or chancre sore, making it difficult for doctors to diagnose the infection.
Dr. Amy Nham, the lead author of the study and a first year EIS officer, also known as a "disease detective," emphasized the importance of healthcare providers screening more diligently and being alert to this trend in syphilis cases.
Syphilis cases are on the rise in the US, with more than 207,000 cases reported in 2022. This is the highest number since the 1950s, according to the US Centers for Disease Control and Prevention.
While men who have sex with men have traditionally been most affected by syphilis, the demographics of the infection have been changing. In recent years, the number of infections has more than doubled in heterosexual men and women since 2019. Additionally, cases of congenital syphilis, where the infection is passed from a pregnant woman to her baby, are also increasing.
Nham was tasked by her supervisors at the Chicago Department of Public Health to investigate cases with unusual symptoms known as NOO syphilis, which stands for neurosyphilis, ocular syphilis, and otic syphilis. This was in response to reports from healthcare providers in the city noting an increase in such cases.
She conducted a search in a citywide database of medical records to identify patients with signs or symptoms consistent with NOO syphilis. A total of 28 individuals met her criteria, with the majority (75%) being male and Black (71%). The age of the patients ranged from 23 to 82 years. While six of them were gay men, approximately half identified as heterosexual. Surprisingly, only one-third of the patients were found to be HIV positive, a lower proportion than expected. This is noteworthy as individuals with HIV typically experience more severe symptoms of syphilis. According to the most recent data from the CDC, over one-third of gay men diagnosed with primary and secondary syphilis also have HIV.
Nham's research discovered that the top symptoms reported by patients were headaches, changes in personality or mental state, and eye issues such as vision changes, light sensitivity, or eye swelling.
According to Nham, these symptoms are not very specific, which is why it is crucial for healthcare providers to conduct thorough screenings and inquire about risk factors, including sexual history, when evaluating patients.
Danae Johnson's granddaughter, Venus.
Danae Johnson's granddaughter, Venus.
Courtesy Danae Johnson
Related article
Rates of congenital syphilis are on the rise in the US. This disease is caused by a type of bacteria known as Treponema pallidum. It progresses in stages, starting with the development of a painless sore called a chancre. These chancres can be found on the genitals, lips, or tongue and may last for several weeks. In some cases, they may go away without treatment, especially if they are small or located in a hidden area.
Syphilis is a tricky infection. Its symptoms can be misleading and resemble those of other illnesses, earning it the nickname "the great imitator."
After the initial sore heals, it may appear that the infection has disappeared, but it has actually gone dormant. The next phase typically begins with skin rashes or sores in the mouth. In addition, individuals may experience general discomfort, such as fever, swollen lymph nodes, fatigue, sore throat, muscle pain, hair loss, and weight loss.
If left untreated, syphilis can progress to a third stage. This stage typically emerges 10 to 30 years after the initial infection and can be fatal.
During any point of the infection, the bacteria can invade the nervous system, affecting the brain, eyes, and ears. Symptoms may include headaches, brain swelling (meningitis), strokes, and mental changes. Additionally, individuals may experience sensitivity to light, swollen eyes, vision problems, hearing loss, dizziness, or tinnitus if the infection reaches the ears.
Nham’s study only looked at Chicago, but she has been collecting case reports and says doctors are seeing similar things in other parts of the country.
Get CNN Health's weekly newsletter
Sign up here to receive The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.
She mentioned that she is not certain about the reason behind the increase in cases with these unusual symptoms as it was not within the scope of her research, but she does have some theories.
The best way to treat syphilis is by getting an injection of a long-lasting antibiotic called Bicillin L-A, but there has been a shortage of this medication for a year.
Since these injections are the most effective treatment during pregnancy, the CDC recommends that healthcare providers give priority to pregnant individuals and newborns when administering the shots.
Men have the option to use a different antibiotic called doxycycline to treat their infections. It is important to note that this medication needs to be taken twice a day for several weeks in order to be effective. Unfortunately, some individuals do not complete the full course of treatment, which can result in their infection lingering and worsening over time.
According to Nham, there may be a rise in untreated or inadequately treated patients, leading to more severe outcomes of syphilis.
Editor's P/S:
The article sheds light on a concerning trend of syphilis patients presenting with atypical symptoms, particularly neurological and sensory issues. This is alarming because syphilis has historically been associated with severe health complications if left untreated. The study's findings emphasize the need for healthcare providers to be vigilant in screening and diagnosing syphilis, as its symptoms can be easily mistaken for other conditions. The rising number of cases with these unusual presentations raises concerns about potential delays in diagnosis and treatment, leading to more severe outcomes.
The article also highlights the importance of addressing the shortage of Bicillin L-A, the most effective treatment for syphilis during pregnancy. This shortage poses a significant risk to pregnant women and their unborn children. It is essential for healthcare providers to prioritize the administration of this medication to pregnant individuals and newborns to prevent congenital syphilis. Additionally, ensuring that patients complete the full course of treatment for syphilis is crucial to prevent the development of more severe complications.
