(PDF) Diagnosis and Treatment of Sexually Transmitted Infections: A Review
Why Syphilis Is On The Rise - Newsweek
Rates of the sexually transmitted infection (STI) syphilis are on the rise, having climbed significantly in the two decades since the early 2000s.
According to a report released by the Centers for Disease Control and Prevention (CDC) on April 11, syphilis is now recorded at rates not seen since the 1950s, and it increased by around 30 percent between 2020 and 2021 alone.
The CDC data shows that in 2020, there were 134,000 cases of syphilis reported in the U.S., which increased to 176,000 cases in 2021. This is a huge jump from the rates of syphilis that were recorded in the early 2000s, where only around 30,000 cases each year were recorded.
A file photo of a blood test for syphilis. A new CDC report has found that syphilis cases rose by 30 percent between 2020 and 2021. A file photo of a blood test for syphilis. A new CDC report has found that syphilis cases rose by 30 percent between 2020 and 2021. ISTOCK / GETTY IMAGES PLUSSyphilis is an infection by a subspecies of the bacterium Treponema pallidum, usually transmitted from person to person via vaginal, anal, or oral sex.
"Syphilis infections are often asymptomatic and also the symptoms mirror many other common conditions, and therefore it can go undiagnosed until it has serious effects. Without treatment, people can spread it to others," Sarah Steele, a senior research associate in Cambridge Public Health at the University of Cambridge, told Newsweek.
"Indeed, the symptoms of syphilis may not be immediately obvious to many, and for those who are symptomatic, symptoms may disappear for a time or mimic other common diseases, leading to misdiagnosis or treatment delay."
Syphilis will usually develop in several stages, known as the primary, secondary, latent, and tertiary stages, with each stage having different symptoms. The first to appear are usually chancres, or small, painless sores or ulcers, often in or around the genitals, or in the mouth that develop between two and six weeks after exposure. In the subsequent stages, a blotchy red rash may appear, often on hands or feet, as well as small skin growths, white patches in the mouth, fatigue, headaches, joint pain, fever and swollen glands.
CDC graph of changes in syphilis case rate over the past decade, also showing the stage of diagnosis. In 2021, 176,713 total cases of syphilis, 51,830 cases of early non-primary non-secondary syphilis, and 53,767 cases... CDC graph of changes in syphilis case rate over the past decade, also showing the stage of diagnosis. In 2021, 176,713 total cases of syphilis, 51,830 cases of early non-primary non-secondary syphilis, and 53,767 cases of primary and secondary syphilis were reported in the United States. During 2020 to 2021, the total rate of syphilis increased 31.7% (40.4 to 53.2 per 100,000), the rate of early non-primary non-secondary syphilis increased 20.0% (13.0 to 15.6 per 100,000), and the rate of primary and secondary syphilis increased 28.6% (12.6 to 16.2 per 100,000). More CDC Sexually Transmitted Disease Surveillance 2021 reportSome people don't experience any symptoms at all, while in others, they resolve by themselves after a short time and the disease then moves into its latent stage, where there also may be no symptoms at all.
"[The latent stage] may last for several years before eventually developing into tertiary syphilis, the most devastating stage that can cause substantial damage to a number of organs, including the heart, eyes, brain and wider nervous system," Simon Bishop, an associate professor of medicine at Anglia Ruskin University in the U.K., told Newsweek. "It's also possible for mothers to transmit the disease to their unborn children, leading to a condition called congenital syphilis that is associated with often quite severe disfigurement caused by bone deformity, as well as a number of other health issues."
The CDC report also found that there was an over 30 percent rise in congenital syphilis between 2020 and 2021.
"If left untreated for years, syphilis can affect the brain or other parts of the body, causing serious long-term problems," Steele said.
This rise in cases seen in the data is likely due to the effects of COVID on the healthcare system and symptoms being missed, as well as changes in the way that people have sex.
"Changes in rates of STIs are attributable in part to behavior changes, especially in higher risk groups, but also the declines in screening participation during the pandemic, alongside the closure of some services due to lack of staff and funding," Steele said. "The redeployment of many people and resources during COVID decimated many services."
It may also be due to a combination of a number of other factors, including the fact that it is often undiagnosed or dismissed as a common cold or flu, and therefore accidentally spread to others.
Bishop suggests that another driver may be a reduction in condom use, both in heterosexual and MSM (men who have sex with men) sexual relationships.
"This in itself has been driven by the advent of PrEP (pre-exposure prophylaxis) drugs that protect against HIV without the need to use condoms, as well as a general population-wide reduction in the fear of HIV infection," Bishop said.
CDC graph showing the difference between 2012 and 2021 in terms of syphilis cases. In 2012, two states, the District of Columbia (DC), and one U.S. Territory (7.4% of areas with available data) had a... CDC graph showing the difference between 2012 and 2021 in terms of syphilis cases. In 2012, two states, the District of Columbia (DC), and one U.S. Territory (7.4% of areas with available data) had a rate of reported primary and secondary syphilis greater than or equal to 7.6 cases per 100,000 population. This increased to 42 states, DC, and one US territory (80.0% of areas with available data) in 2021. American Samoa and the Commonwealth of the Northern Mariana Islands began reporting data on primary and secondary syphilis cases to CDC in 2018; data are not available for those areas prior to that year. Due to a network security incident in December 2021, the Maryland Department of Health could not finalize its 2021 STD case notification data. More CDC Sexually Transmitted Disease Surveillance 2021 report"A general increase in casual sex within some populations, in part driven by apps such as Tinder and Grindr – the more people that one has unprotected sex with, the greater the risk. In recent years the public health focus has been on chlamydia, primarily because it's more widespread as an STI and easier to diagnose," he said. "As a result, syphilis has been a little neglected – it's still tested for in blood-based sexual health screenings and routinely in pregnant women etc, but doesn't hold the same place in the public's consciousness as some other infections."
The CDC report also found that the 2021 rates of chlamydia and gonorrhea far outpaced those for syphilis, with over 1.6 million cases of chlamydia reported in 2021, and over 700,000 cases of gonorrhea. The figures marked a 4 percent increase in chlamydia from the 2020 numbers, and a 4.6 percent rise in gonorrhea.
"In terms of [syphilis's] relative severity compared to other STIs, although diseases such as chlamydia, gonorrhea and herpes can cause some unpleasant symptoms, and HPV and hepatitis B/C can lead to cancers (typically cervical/oral and liver respectively), none of these have the same combination of ease of transmission and multi-organ involvement as untreated syphilis," Bishop said.
This rise in cases isn't disastrous, as the disease can be treated with antibiotics. As with many bacterial infections, however, syphilis has begun to develop some degree of resistance to many drugs.
"Although syphilis can be easily treated with antibiotics (usually benzathine penicillin G) there is some evidence for the emergence of drug resistance," Bishop said. "If this happens, the disease risks becoming much more difficult to treat, making its prevention and early diagnosis even more important."
Steele stresses that while these increases in cases may seem large, syphilis is still contracted in much lower numbers than many other STIs, including chlamydia and gonorrhea.
"It's also important to remember syphilis remains low in terms of absolute numbers, so a small increase expressed as a percentage can seem much more significant an increase than other STIs," she said.
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Syphilis Cases Are On The Rise. The FDA Just Approved A Home Test That ...
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Soon you will be able to test for syphilis at home, thanks to a first-of-its-kind approval from the Food and Drug Administration this week. The test could help curb a recent uptick in infections of the sexually transmitted infection. Here's what you need to know.
What is syphilis? How is it spread?Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Syphilis is typically spread through direct contact with a syphilis sore, known as a chancre, during vaginal, anal or oral sex. It can also be passed from a pregnant person to a child during birth. Despite misconceptions, people cannot get syphilis through shared contact with things like doorknobs, toilet seats or swimming pools.
What's happening now?The FDA just approved the first at-home test to detect syphilis antibodies, which will make it easier for people to screen themselves for this sexually transmitted disease. The test from NOWDiagnostics gives results in about 15 minutes; however, a positive result should be followed up with a visit to a medical professional in order to confirm the diagnosis.
The hope is that these tests will boost syphilis screening rates, allowing people to take action before they can spread the infection.
What are the symptoms of syphilis?There are four stages of syphilis, each with specific symptoms. In the primary stage, a person may develop sores at the site of infection, typically on the genitals, anus or mouth. The secondary stage can cause skin rashes, sores in the mouth or genital area, fever, swollen lymph nodes and other symptoms like headaches and muscle aches. The third stage, called the latent stage, has no visible symptoms.
The final stage, known as the tertiary stage, can lead to severe complications, attacking internal organs and causing severe neurological symptoms, as well as loss of sight and hearing. This can occur 10 to 30 years after initial exposure.
What to know about pregnancy and syphilisIf you are pregnant and have syphilis, it is possible for the infection to lead to a miscarriage or stillbirth. Babies born may be premature or have a low birthweight.
Babies who are born with congenital syphilis may not show any symptoms initially, but they will have serious issues later on if the infection is left untreated. However, others may suffer from bone deformities, severe anemia, enlarged liver and spleen, jaundice and severe neurological problems like blindness or deafness, per the Centers for Disease Control and Prevention.
Congenital syphilis cases have more than tripled in recent years, with over 3,700 cases reported in 2022, according to the CDC. This is the highest number since 1994.
How is syphilis treated?Penicillin is the most commonly used antibiotic to treat syphilis. Other options may be used if you are allergic to penicillin, or your doctor may recommend a regimen that will allow your body to get used to the antibiotic before treatment, which is required for pregnant individuals. Typically, a single shot of penicillin will treat the STI, though more doses may be required depending on the stage of your illness.
Why are we talking about syphilis now?Syphilis cases are rising and have been for decades, even as cases of other STIs like chlamydia and gonorrhea are decreasing or remaining steady.
In 2022, more than 200,000 cases of syphilis were diagnosed in the United States — an 80% increase from 2018. It's the highest level since the 1950s, when people did not have readily available treatment plans and had limited knowledge of the disease.
One reason experts point to for the rising cases is the "decrease in funding for sexual health services and programs throughout the last couple of decades," Kristen Krause, deputy director for the Center for Health, Identity, Behavior and Prevention Studies at the Rutgers School of Public Health, previously told Yahoo Life. This means fewer people are getting tested for syphilis, including people who can spread it to partners or children during birth.
Earlier this year, the U.S. Department of Health and Human Services announced plans to fight the syphilis epidemic, which included addressing drug shortages, enhancing community input through workshops and expanding syphilis prevention and treatment efforts, particularly in populations most affected by the epidemic. This includes American Indian and Alaska Native people, as well as Black and Hispanic communities. Men who have sex with men are also more likely to be affected by syphilis.
Experts Are Concerned By The Rate Of Babies Dying From This STI
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