Dr. Francisco R. Velázquez and Kirsten Duncan: Syphilis is on the rise

By Dr. Francisco R. Velázquez and Kirsten Duncan

Through the remainder of June, we will see a number of billboards, advertising and communications highlighting the current state of syphilis in Spokane County. Why is that? Unfortunately, syphilis is on the rise in Spokane County. In the past 10 years, diagnosed cases have increased dramatically from 27 cases in 2014, to 380 cases in 2023. Preliminary reports in 2024 show that cases of infectious syphilis have increased 30% from last year.

Along with increases in cases, we’ve seen more people suffering the permanent impact of untreated disease such as loss of vision and paralysis. Most concerning, we’ve seen a dramatic increase in cases of infants born with syphilis, with more cases identified in 2024 than the past two years combined. Syphilis in infants is entirely preventable through early detection and treatment during pregnancy.

Syphilis, caused by the bacteria Treponema pallidum, is transmitted in one of two ways: through sexual contact with someone who has certain symptoms of syphilis, or in utero through the placenta during pregnancy. Clinical signs of sexually acquired syphilis begin with the appearance of a sore or ulcer where sexual contact occurred. Often this is in the mouth, genitals, or rectum and can be easily missed as it is often painless and located in areas that the person cannot see. The sore or ulcer is usually present for around a month before it disappears.

Days to months after the sore goes away, potentially widespread clinical signs and symptoms begin. Commonly, people will have a red, spotty rash on their stomach, arms or legs that can also be on the palms of hands and soles of feet. People may also experience white patches or wart-like growths in the mouth and genital/rectal area, hair loss, sore throat, fatigue and low-grade fevers. These symptoms may come and go over a period of months, others may only have mild symptoms.

It may take up to a year for symptoms to fully resolve. Most symptoms of syphilis appear identical to common health conditions such as dermatitis, herpes, alopecia, oral thrush and cellulitis. Because of this, it can take multiple doctor’s visits before syphilis is considered or tested for, which delays diagnosis and can increase the number of people exposed to the bacteria.

Treatment with specific antibiotics will cure the infection. If you are not treated, the bacteria remain in your body after symptoms improve, causing damage over time such as vision loss, hearing loss, paralysis and death. Syphilis can also impact your vision, hearing, central nervous system, spinal cord and peripheral nervous system. This can occur at any time during the infection, including when a sore is first detected. People with this complication will experience sudden changes in vision, hearing, psychosis, depression, personality changes, delirium and even dementia.

Syphilis is very harmful during pregnancy. Untreated syphilis during pregnancy can result in stillbirth. If the infant is born alive, they can have significant, irreversible damage including developmental disabilities, neurologic deficits, loss of vision and loss of hearing. If you are pregnant, it’s important that you get tested three times during the pregnancy: 1) when initially seeing your provider, 2) around 28 weeks, and 3) at delivery. If a test is positive, treatment should be given as soon as possible to prevent the infection from impacting the pregnancy.

Anyone who has sex can get syphilis. Although symptoms like the sore and rash tell us the person has only had syphilis for a few months, syphilis can also be diagnosed years or decades after the last time a person had sex. The only way to know if you have syphilis is through a blood test. Syphilis cannot be identified or diagnosed using urine or swabs collected when testing for other sexually transmitted infections such as gonorrhea, chlamydia or herpes.

In order to prevent the disease from spreading even more in our community, we are urging people to ask their health care provider about being tested for syphilis. All sexually active individuals should be tested at least once a year, and testing can be completed up to every three months if you have increased concern for exposure. If you are diagnosed with syphilis, get treated right away, and please tell all sexual partners in the year leading up to your diagnosis that they should be tested. If you believe you have been exposed to syphilis in the previous three months, you should be treated at the time of testing. There can be a long period when tests are negative, but the bacteria are still present. Treatment during this time will stop you from developing symptoms.

Syphilis is a preventable disease. Practicing safe sex and judicious use of barrier protection can decrease the risk of exposure. Getting tested regularly, understanding the risks, signs and symptoms, and having honest conversations with your partners can go a long way in disease prevention. Syphilis can be cured, and treatments are most effective if they’re given while you’re in the early stages of the infection. The sooner it’s diagnosed and treated, the less risk of having complications and of infecting others.

Francisco R. Velázquez, M.D., S.M., FCAP is the health officer the Spokane Regional Health District. Kirsten Duncan, MPH, is lead disease investigation specialist for the Spokane Regional Health District.