Sexual Health Expert Explains How to Recognize the First Sign of Syphilis 

"This just hasn’t received priority like other diseases."

Syphilis is called the “great pretender” for a good reason: The disease, which starts with a small, painless sore but continues to worsen over time, is sometimes hard to recognize. It’s crucial to screen for and catch syphilis right away, but unfortunately that doesn’t always happen. As a result, the age-old disease has once again gained ground in recent years. Here, researchers explain to Inverse how to catch it before it can wreak havoc on the body.

Syphilis is an infection caused by the bacteria Treponema pallidum and is usually transmitted during sex. It can also, however, be passed via shared needles and sex toys, or, occasionally, from mother to child. Once it infects a person, the disease progresses in four increasingly dangerous phases. Usually, the first sign of an infection is the presence of a single sore — a chancre — which usually turns up on the genitals, anus or mouth. Recognizing that sore is a key moment in the treatment of the disease, but unfortunately, many people either don’t see it or don’t realize what it is.

“The consequences are extreme, but the treatment is relatively straightforward,” Susan Michaels-Strasser, Ph.D., an assistant professor of epidemiology at Columbia University Medical Center, tells Inverse.

syphilis
Treponema pallidum, the bacteria that causes syphilis. 

Recognizing a Syphilis Sore

Michaels-Strasser explains that the sore is actually a lesion that looks similar to a burn, minus the blistering that a burn usually leaves behind. It can’t actually be popped, though it can bleed on occasion, which may spread the bacteria to other people. The CDC’s website has pictures intended to help people recognize the sores.

“For women, the chancre could be hidden in the vagina and they may not see it,” she says. “For men they may see a sore, but because it’s painless they may discount it. Some may go for treatment, others may go in for treatment and say, ‘Oh, let it heal’. But the infection is still in the body.”

As the disease progresses, the sore will heal, she explains. The problem is that the infection that lingers in the body after can worsen. In the second stage, it becomes a rash. This, too, Michaels-Strasser adds, is often mistaken for an allergic reaction or goes unnoticed. If syphilis progresses to the third and fourth stages, as it does in about 15 to 30 percent of people who don’t get treated, it can cause heart, brain or nerve damage, sometimes years after the initial infection.

“A person can go their life but not knowing they have it but then these severe things suddenly develop,” she says. “It’s been working on your body, and then you see the level of damage it has done.

A Spike in US Syphilis Cases

Fortunately, in the United States, screening for syphilis is routinely done for pregnant women and is recommended by the CDC for everyone, “on the basis of the local area and institutional prevalence.” That way, the spread of the disease doesn’t depend on the discovery of a small, painless sore.

But even though screening is supposed to be routine, it doesn’t always happen.

In August 2018, the CDC released data showing that syphilis cases had increased 10.5 percent from 2016 to 2017. Cases had been steadily rising since the 2000s, and were up 72.7 percent since 2013. Even more recently, in 2017, the number of children born with congenital syphilis (which happens when the condition is passed from mother to child) was higher than it had been in 20 years: That year, 918 kids were born with the disease.

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Congenital syphilis cases (or cases of the disease in newborn children) have increased since 2013.

When those numbers were released, Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, issued a statement noting that these increases were symptomatic of public health failure.

“We are sliding backward,” he said. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

Michaels-Strasser argues that the resurgence of syphilis is actually a sign that it’s a fairly overlooked disease. This, she adds, is particularly frustrating because once it’s identified, syphilis is easy to treat — unlike many other STIs. Primary and secondary syphilis is usually treated with just one injection of penicillin. “It’s clear that routine testing is really really important. But it’s not done everywhere.” she adds.

The important thing, she reiterates, is to spot symptoms of the disease early, either by knowing what to look for or by getting tested by experts that do know how to recognize it. If we’re going to really start to tackle syphilis, she argues that prioritizing it will be key.

“This just hasn’t received priority like other diseases,” she says. “It’s something that people have to continue to advocate for.”