The California Department of Public Health is calling syphilis “an epidemic” here in the state, and Planned Parenthood of the Pacific Southwest is responding.
“Syphilis is an STI [sexually-transmitted infection] that’s been around a long time but tended to be isolated to the southern states,” said Dr. Toni Marengo, medical director of Planned Parenthood of the Pacific Southwest. “You’d hear about it, but it was far less common in California.”
Many people with syphilis may not know they have it. Symptoms can lay dormant, then progress through different stages.
“Syphilis can be symptomatic for some (presenting as a painless ulcer known as a chancre). It can progress to an asymptomatic stage and then possibly develop into neurological symptoms,” said Dr. Marengo. “A person might have a non-itchy rash on their palms or soles of their feet in the second stage of syphilis. Syphilis can also progress to affecting the internal organs, dementia, or paralysis in the tertiary stage.”
Syphilis can be treated with antibiotics. But if a mother is untreated and gives birth, there can be severe complications.
“When women are of reproductive age and become pregnant, they can end up passing syphilis to the fetus. Signs of syphilis can sometimes be detected during the second trimester ultrasound, but not always. Her options may then become limited in terms of continuing a pregnancy.”
Pregnant mothers are screened for syphilis when their prenatal labs are drawn. “It is important for them to know that babies exposed to syphilis, especially early in pregnancy, are at increased risk of preterm birth and of being stillborn. Neurological problems associated with syphilis exposure may not be detected until after a baby is born,” said Dr. Marengo.
Syphilis can be disabling and life-threatening in an infant.
“It’s spread through the placenta. There can be congenital anomalies, developmental delay, seizures,” Dr. Marengo said.
Of the 283 congenital syphilis births in California in 2017: 6% were stillborn, 10% had bone abnormalities, and 30% were preterm births. Of this group of women who gave birth, 35% had received no prenatal care.
It was the 5th consecutive year that congenital syphilis cases have increased in California.
The groups that are most vulnerable to contracting syphilis mirror those at risk for contracting HIV, for example: IV drug use, men who have sex with men, and/or people with multiple partners.
“It’s a blood-born pathogen, so these behaviors put a person at greater risk for contracting syphilis as well as HIV,” said Dr. Marengo.
There are several reasons why syphilis cases are on the rise, among them a lack of public health funding and decreased condom use.
“One reason condom use may be on the decline is that our adolescents and young adults today do not have the same fear of STIs that was present in the 1980s. At that time, HIV was considered a 'death sentence,' and although there is still no cure, scientific advancements have allowed the condition to be much better managed today. Combine that with a push toward abstinence-only education in some schools due to more conservative legislators, and we have less education about how sexually transmitted infections are obtained and less education in general about condoms.”
The most important thing you can do to protect yourself from syphilis (and other STIs)? Wear condoms.
In the meantime, Planned Parenthood is ramping up our efforts to increase awareness of this infection and is making a statewide effort to increase screening for Californians.
“If you come in for an HIV test, get tested for syphilis too,” said Dr. Marengo. “We should test you at least once in your life, and more frequently if you have increased risk factors.”
To make an appointment for STI testing, visit planned.org or call 1-888-743-PLAN.
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