A Woman With a Rash on Her Palms and Soles

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.

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Rare Symptoms Popping Up Among Syphilis Patients, Physicians Say

Strange symptoms in syphilis cases are appearing sooner and in higher incidence rates than normal, CNN reported April 26. 

Syphilis prevalence has been rising for at least 12 years, and HHS recently deemed the sexually transmitted disease part of a "surging epidemic." Chicago Department of Public Health researchers lately noted an uptick in NOO syphilis — or neurosyphilis, ocular syphilis and otosyphilis — which can permanently damage a patient's vision and hearing, and cause psychiatric changes. 

Typically, NOO syphilis happens when the infection has been untreated and undiagnosed for years. In Chicago last year, researchers reported 28 cases, and about one-third were in the early stages of infection. 

"Providers definitely need to be screening more and be aware that this is what we're seeing," Amy Nham, PharmD, lead study author and CDC epidemic intelligence service officer, told CNN. 

The most common symptoms included headaches, vision loss, sensitivity to light, swelling in the eye and personality changes or altered mental status. 

"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" and their sexual history, Dr. Nham told CNN.

Unusual, Severe Symptoms Reported By Doctors Treating Syphilis

Vision issues, headaches, and hearing loss are among unusual symptoms being reported in the current syphilis surge. Separately, reports detail how St. Louis, facing the highest syphilis rates per capita in any Missouri county, will tackle the outbreak.

CNN: Doctors Warn They're Seeing Syphilis Patients With Unusual And Severe Symptoms Disease detectives in Chicago say they have been seeing a worrisome trend: Patients complaining of unusual symptoms like vision and eye problems, headaches and hearing loss or dizziness caused by the sexually transmitted infection syphilis. (Goodman, 4/26)

St. Louis Public Radio: How St. Louis Plans To Address Rising Syphilis RatesSt. Louis has the highest rate of syphilis cases per capita of any county in Missouri. In 2022, the year with the latest data available, St. Louis reported nearly 600 cases of the bacterial infection, which is spread through unprotected sex with a person with the disease. Health officials have also seen an increase in syphilis and HIV co-infection and congenital syphilis in newborns. (Fentem, 4/29)

On measles —

CNN: Global Measles Cases Nearly Doubled In One Year, Researchers SayThe number of measles cases around the world nearly doubled from 2022 to 2023, researchers say, presenting a challenge to efforts to achieve and maintain elimination status in many countries. (Dillinger, 4/27)

ABC News: More Than 150 People In West Virginia Exposed To Measles: Health OfficialsAbout 152 people across 30 counties in West Virginia have been exposed to measles, state health officials said Friday. Earlier this week, the first confirmed case of measles in the state since 2009 was identified, according to the West Virginia Department of Health (WVDH). The patient was someone who was undervaccinated and had a history of recent international travel, the department said. (Kekatos, 4/26)

On hepatitis C, malaria, and polio —

The New York Times: U.S. Lags Behind Other Countries In Hepatitis-C Cures Despite an arsenal of drugs, many Americans are still unaware of their infections until it's too late. A Biden initiative languishes without Congressional approval. (Alcorn, 4/28)

CIDRAP: Monoclonal Antibody Offers Strong Malaria Protection In ChildrenToday in the New England Journal of Medicine a study demonstrates that a single subcutaneous (just-under-the-skin) injection of an experimental malaria monoclonal antibody offered up to 77% protection against malaria for children in Mali during a 6-month malaria season. (Soucheray, 4/26)

Reuters: Wiping Out Polio 'Not Guaranteed', Support Needed, Bill Gates Says Success in the fight to wipe out polio is not guaranteed, according to tech billionaire turned philanthropist Bill Gates, whose foundation has poured billions into the effort. Gates warned against complacency in tackling the deadly viral disease as he welcomed a $500 million pledge from Saudi Arabia on Sunday to fight polio over the next five years, bringing it in line with the U.S. As one of the biggest national donors. (Rigby, 4/28)

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