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Significant increases in syphilis cases

More testing and safer sex practices urged to combat yearslong rise of infections.

A persisitent spike of syphilis cases over the last few years has Kaiser Permanente clinicians urging more testing for sexually active people — especially those who are pregnant.

Syphilis is curable with antibiotics even in its physically- and neurologically-damaging late stages, but the damage is not reversible once it gets to that stage. The sexually transmitted disease is extremely dangerous for babies who contract it in the womb. When a fetus is infected, it is known as congenital syphilis.

“When a child is born with congenital syphilis, there can be significant issues, including still births, premature births, and several in-utero complications: collapse of the nose, problems with the eyes, bone issues, abnormal teeth, and hearing loss, among others” said Jeffrey Sperling, MD, regional chair of Maternal-Fetal Medicine. “That’s why it is so important to have appropriate testing.”

Anyone who has sex is at risk. But those who have many partners, those who have sex when using drugs, men who have sex with men, and those who are not getting tested and not using condoms are more at risk.

Amanda Thornton, MD

Congenital syphilis can be treated with antibiotics to prevent further harm, but many of the birth defects it causes are not reversible.

From 2017 to 2021, the number of children born with syphilis in California increased 83% to 528 cases, according to the most recent data provided by the California Department of Public Health. The number of women who contracted syphilis grew 126% to 2,102 cases in the same period.

Nationally, there were more than 3,700 babies born with syphilis in 2022, more than 10 times the number reported in 2012. The total number of cases for 2022 was 207,255, which was the highest number of cases since 1950.

Testing made easy

To help lower the number of babies born with syphilis, Kaiser Permanente in Northern California is considering a third syphilis test for pregnant patients when they give birth. Already, two tests are performed during pregnancy: one during their first prenatal visit and a second during the third trimester, said Dr. Sperling. The third test was recently recommended by the American College of Obstetricians and Gynecologists.

For those who are not pregnant, Kaiser Permanente in Northern California has made syphilis testing easier than ever.

A request for the blood test can be done online under the E-visits tab, which eliminates the need to request a test from a doctor, said Amanda Thornton, MD, an infectious disease specialist who helped create the online testing access. The online request eliminates the stigma associated with talking to a doctor or nurse to request a test.

“Any member can log in to choose the appropriate test,” said Dr. Thornton. “You can do this without speaking to anyone. It’s been very popular.”

Syphilis can be contracted through all forms of sex, she said.

“You can even get it from oral sex if there are active lesions,” said Thornton. “Anyone who has sex is at risk. But those who have many partners, those who have sex when using drugs, men who have sex with men, and those who are not getting tested and not using condoms are more at risk. Women aiming to get pregnant are at risk because they are having unprotected sex.”

Using male or female condoms, regular testing, and being in a mutually monogamous relationship can help prevent syphilis and other sexually transmitted diseases, added Dr. Sperling.

Possible reasons for the uptick

Both Drs. Sperling and Thornton concede there is no single reason for the sharp rise in syphilis cases. Rather there are several possible theories.

“I would pin a lot of it on the COVID-19 pandemic when people did not stop having sex, but they were not about to go into a doctor’s office or lab to get tested,” said Dr. Thornton. “After COVID, the testing rates are still not up to what they were before.”

Social media, which makes casual sex easier and more convenient, might also be contributing to the high numbers, said Dr. Sperling. Then there is a recent surge in syphilis among those who use methamphetamine.

“We really don’t know why the numbers are so high, but we do know that frequent testing, appropriate treatment, and using protection can help prevent its consequences,” he said.


maternal healthsexually transmitted diseasesyphilis

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