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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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Amid STD Epidemic In The US, A Rise In Symptoms Of Eye Syphilis: What Is It?
The CDC warns that without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis). (Photo: Freepik) According to news reports, patients have recently started to complain of vision and eye problems, headaches and hearing loss or dizziness caused by the sexually transmitted infection syphilis.In the US, there is a current epidemic of syphilis amid which, doctors are also seeing a worrisome trend of patients presenting with 'unusual vision and eye symptoms'. According to news reports, patients have recently started to complain of vision and eye problems, headaches and hearing loss or dizziness caused by the sexually transmitted infection syphilis. A CNN report stated that doctors have long known that syphilis can 'permanently damage' a person's vision and hearing, and even lead to 'psychiatric changes'. But, these symptoms are usually seen with infections that have been 'undiagnosed and untreated' for years.
In a new study presented recently at the 2024 Epidemic Intelligence Service Conference in Atlanta, researchers said there were 'more than two dozen cases with these kinds of symptoms' in Chicago last year, and a third of them were in the early stages of infections.
According to a People report, a January 2024 Centers for Disease Control and Prevention (CDC) report stated that more than 2,07,000 Americans were diagnosed with syphilis, the highest reported number since the 1950s. The CDC warns that without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis).
What Is Syphilis And How Does It Spread?According to the CDC, syphilis is a sexually-transmitted infection (STI) that can cause serious health problems without treatment. Infection develops in stages (primary, secondary, latent, and tertiary), and each stage can have different signs and symptoms. One can contract syphilis by direct contact with a syphilis sore during vaginal, anal, or oral intercourse. It can also spread from a mother to her unborn baby. Syphilis, however, does not spread through casual contact with objects like toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, sharing clothing, or eating utensils.
Signs And Symptoms Of SyphilisAs mentioned earlier, there are four stages of syphilis: primary, secondary, latent, and tertiary. Each stage has different signs and symptoms, the CDC states.
Primary StageYou may notice a single sore or multiple sores; the sore is the location where syphilis entered your body. These sores usually occur in, on, or around the male genitalia; vagina; anus; rectum; and lips or in the mouth. Sores are usually (but not always) firm, round, and painless, and because they are painless, you may not notice them. They last 3 to 6 weeks and heal regardless of whether you receive treatment. But, even after the sore is gone, you must receive treatment.
Secondary StageYou may have skin rashes and/or sores in your mouth, vagina, or anus. It usually starts with a rash on one or more areas of the body. The rash can show up when the primary sore is healing or several weeks after the sore has healed. The rash can be on the palms and/or the bottoms of your feet. They are rough; red; or reddish-brown. The rash usually does not itch. Other symptoms are: fever; swollen lymph glands; sore throat; patchy hair loss; headaches; weight loss; muscle aches; and fatigue. The symptoms will go away whether you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.
Latent StageThere are no visible signs or symptoms. Without treatment, you can continue to have syphilis in your body for years.
Most people with untreated syphilis do not develop tertiary syphilis. When it does happen, it can affect many different organs, including the heart and blood vessels, and the brain and nervous system. It is very serious and occurs 10-30 years after the infection started. Tertiary syphilis can also result in death.
Ocular Syphilis And OtosyphilisThe signs and symptoms of ocular syphilis include:
Signs and symptoms of otosyphilis may include:
Lead study author Dr Amy Nham -- who works with the Chicago Department of Public Health, told CNN: "Providers definitely need to be screening more and be aware that this is what we're seeing." The latest study findings also suggest that the most common symptoms reported by patients are 'headache', 'personality changes', 'altered mental status' and 'eye problems like vision loss, light sensitivity or eye swelling', per the outlet. "They're not the most specific symptoms, which is why it is really important that providers are doing appropriate screening and asking patients for risk factors," Nham added.
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Disease 'detectives' Spot Worrying New Trend As Cases Of 15th Century STI Surge
DISEASE 'detectives' have spotted worrying new trend in people suffering with early stages of syphilis, who reported vision and hearing loss.
It's not unheard of for the 15th century sexually transmitted infection (STI) to damage people's eyesight or hearing if it's gone untreated for years.
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It's not unheard of for syphilis to cause eye or ear issues in the later stages of infectionCredit: PA:Press Association2
But Chicago based researchers have warned that syphilis sufferers are reporting these symptoms in the early stages of their infectionsCredit: Getty ImagesBut new research presented at the 2024 Epidemic Intelligence Service Conference in Atlanta claims syphilis sufferers are reporting these typically late-stage symptoms in the early stages of their illness.
Chicago-based researchers said 28 people reported these kinds of symptoms in the city last year and nearly a third of them were in the early stages of their infection.
On top of this, more than a third of these patients (68 per cent) hadn't experienced other symptoms typically caused by syphilis, like rashes or sores on their genitals or mouth, as reported by CNN.
Doctors often use these kinds of symptoms to spot if someone has syphilis, so it was worrying to researchers that some patients weren't getting them.
"Providers definitely need to be screening more and be aware that this is what we're seeing," said Dr Amy Nham, lead study author and one of the "disease detectives" assigned to the Chicago Department of Public Health.
Syphilis is an STI that can cause serious health problems if goes untreated.
It typically spreads via direct skin-to-skin contact, according to the NHS, most commonly through unprotected vaginal, anal or oral sex with someone who is infected.
But it can also be passed on to an unborn baby during pregnancy, which is referred to as congenital syphilis.
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Watch transformation of woman whose 'hazelnut' lump grew to 'cape' tumourSyphilis was rife during medieval times, with an epidemic erupting in Europe in the mid-1490s.
It remained a significant medical problem until the mid-20th century, with medical advances leading to better treatments and a dramatic drop in case numbers.
I'm a GP - here are 5 symptoms you have chlamydia and how you can treat itSadly, this wasn't the last we saw of the 15th century STI, as cases have increased in the last few years.
Recent government figures showed that syphilis diagnoses in England surged to their highest level since 1948 following trends seen in the US, where the disease reached highs not recorded since the 1950s.
Meanwhile, the World Health Organization estimated that 7.1million adults aged 15 to 49 acquired it globally in 2020.
In the US, men who have sex with men have historically been most affected by syphilis.
But infections in heterosexual men and women have more than doubled since 2019, with congenital syphilis also on the rise.
Dr Nham was tasked with examining syphilis cases with unusual symptoms - known as neurosyphilis, ocular syphilis, and otic syphilis or NOO syphilis - after Chicago health providers flagged their were noticing an uptick.
After combing through medical records dated between January and August 2023, she identified 28 people with NOO syphilis, 75 per cent of them men and 71 per cent Black, aged between 23 and 82.
About half said they were heterosexual, while six of them were gay men.
One in three of the patients (32 per cent) were HIV-positive.
Dr Nham said she'd expected more of them to be so, as having HIV can make syphilis symptoms more severe.
Symptoms of syphilis and its stages
THE symptoms of syphilis are often mild, making them difficult to spot.
They also tend to change over time, and come and go, so it is easy to presume you aren't infected, even when you are.
The most common symptoms of the infection include:
These signs may not appear until three weeks (or more) after you're infected.
Sometimes the symptoms can improve or go away completely, but if you have not been treated the infection is still in your body.
This means you can still pass it on and you're at risk of getting serious problems later on.
Potential complications include:
Syphilis tends to happen in stages.
Some of these problems may not appear for many years after being infected with syphilis.
At any point in the infection, syphilis bacteria - Treponema pallidum - can invade the nervous system and affect the brain, eyes or ears.
This may cause headaches, brain swelling, strokes, and mental changes.
Eyes may become sensitive to light or swollen, or sight may be affected and people may also experience hearing loss, dizziness, or tinnitus if the infection reaches their ears.
Source: NHS, WHO, CDC
Nineteen of the 28 patients didn't have typical syphilis symptoms like chancre sores or rashes.
The most common symptoms patients experienced were headaches, personality changes or altered mental status, and eye problems like vision loss, sensitivity to light or eye swelling.
"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," Dr Nham said.
The study only zeroed in on syphilis cases in Chicago, but Dr Nham said she'd been collecting case reports from other parts of the US and said doctors are seeing similar trends in other parts of the country.
She speculated that the rise in atypical symptoms could be due to shortages of syphilis treatments in the US.
The preferred treatment for syphilis, an injection of long-acting penicillin called Bicillin L-A, which has been in short supply for a year.
Dr Nham warned: "There could just be an increase in untreated or inadequately treated patients, which is leading to more severe outcomes of syphilis."
It comes after a cluster of eye syphilis infections was reported in Michigan, after five women slept with the same man.
In the UK, doctors were warned to be on the lookout for syphilis in all pregnant women under new NHS guidelines, after medics flagged "increasing number of diagnoses" of the medieval STI in both expectant mums and unborn babies.
Experts syphilis can be treated if caught early, but it can be serious and potentially life threatening in the long-term if it isn't caught.
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