Syphilis, a potentially serious sexually transmitted infection (STI), is on the rise. From 2018 to 2022, cases increased by more than 80% in the U.S.
What’s causing this sharp increase, and what can you do to protect yourself? Smitha Gudipati, M.D., an infectious disease physician at Henry Ford Health, talks about the rise in cases, how to avoid syphilis and when to get tested.
What Is Syphilis?
Syphilis is a bacterial STI that spreads through anal, oral and vaginal sex and from mother to baby during pregnancy. Without treatment, syphilis can eventually lead to serious complications like organ failure. The disease can also cause severe health issues or stillbirth in newborns.
“Fortunately, syphilis is treatable with certain types of antibiotics,” says Dr. Gudipati. “When it’s treated in the earlier stages, we can prevent its devastating effects.”
Why Are More People Getting Syphilis?
While it’s hard to point to a single reason for the rise in cases, there are likely a few causes, including:
- Less testing during COVID-19: “During the pandemic, many people had to delay getting their routine health screenings, including STI testing,” says Dr. Gudipati. “Now that people are going back to their providers, people are getting tested. As a result, we’re seeing the number of cases spiking.”
- Shortage of antibiotics: Penicillin G benzathine, a type of antibiotic, is a go-to treatment for syphilis. “There was a shortage of this medication, which requires only one dose to cure syphilis in the early stages,” says Dr. Gudipati. “Other antibiotics work, but they require a person to get multiple doses. Missing one or more doses means the syphilis may not go away.”
- Sneaky symptoms: “Many people don’t know they have syphilis because symptoms can be mild,” says Dr. Gudipati. “You may only get one or two sores or a small rash in the early stages, and they’re often painless. It’s easy to pass it off as something else. Some people have no symptoms at all.”
Should I Get Tested for Syphilis?
Testing is a key step towards stopping syphilis in its tracks. “Getting tested for STIs can be stressful, but we need that information to start your treatment,” says Dr. Gudipati. “Having answers can also give you peace of mind if you’re worried about whether you might have an STI. You’ll also be able to prevent transmission of these infections to others.”
You may need regular syphilis testing if you’re sexually active and:
- Are a gay or bisexual male
- Are pregnant (syphilis testing should be done during your first prenatal visit and additional visits when needed)
- Have a sexual partner who tested positive for syphilis
- Have HIV
- Have multiple sexual partners
- Haven’t used barrier protection like condoms and dental dams
You can get testing at your primary care provider’s office or a health clinic. “Local health departments and sexual health clinics offer STI testing if you can’t or don’t want to see your regular provider,” says Dr. Gudipati. “The syphilis test requires a small blood sample. You can also get tested for other STIs at the same time.”
If you do test positive for syphilis, try not to panic. “If you’re in the early stages of the disease, you may only need one antibiotic injection to cure syphilis,” says Dr. Gudipati. “In the later stages, you may need an injection once a week for three weeks. The most advanced stages of syphilis require intravenous (IV) medications.”
In some cases, your provider may prescribe antibiotic pills instead of an injection. “Your provider will explain your treatment plan, and be sure you take the medicine exactly as prescribed,” says Dr. Gudipati. “Taking the full course of medication is essential for curing the infection.”
Tell any current or former sexual partners about your test results, too. “No one looks forward to telling others that they have an STI, but it’s important,” says Dr. Gudipati. “You’re helping others get the testing and treatment they may need.”
Syphilis Prevention Strategies
Syphilis treatment is effective, but prevention is even better. You can greatly lower your chances of getting syphilis if you:
Have only one sexual partner
If you’re sexually active, being in a monogamous relationship (not having multiple sexual partners) can help prevent syphilis and other STIs. “Both you and your partner should be tested for syphilis to be sure you won’t give it to the other person,” says Dr. Gudipati.
Use barrier protection every time
When used correctly and consistently, latex condoms and dental dams can prevent syphilis, HIV and other STIs. “It’s important to know how to use them correctly,” Dr. Gudipati says. “You also need to avoid oil-based lubricants during sex because they can damage the latex.”
Take antibiotics after unprotected sex (for some populations)
Taking a single 200 milligram dose of doxycycline, an antibiotic, after unprotected sex could help prevent syphilis infection in some people. “Men who have sex with men and transgender women may benefit from taking this medicine after unprotected sexual activity,” says Dr. Gudipati. “Studies show it can prevent up to two-thirds of syphilis cases in these populations if the person takes it within the first three days.”
Ask your provider if you should keep a dose of doxycycline on hand. “The sooner you take it after sex, the better,” says Dr. Gudipati. “It’s a good backup to have if the condom breaks or you forget to use protection.”
Be Open with Your Provider
It can be hard to talk to your provider about your sexual health, but they’re not here to judge. “The stigma around STIs interferes with people getting the testing and treatment they need,” says Dr. Gudipati. “Your healthcare provider is a safe space for you, so be open about your sexual health. We’re here to help you get healthy.”
Reviewed by Smitha Gudipati, M.D., an infectious disease physician at Henry Ford Hospital - K Building.
