Syphilis Cases Surge: Challenges Mount for Diagnosis and Treatment

Visual Representation for Syphilis Infection | Credits: Getty Images
Visual Representation for Syphilis Infection | Credits: Getty Images

United States: Amidst the rapid surge of syphilis cases across the United States and globally, medical practitioners find themselves challenged to elevate their proficiency in both diagnosing and treating this often overlooked infection.

Exceeding 200,000 reported cases in 2022 alone, marking the highest tally since 1950 with a notable 17.3 percent surge compared to the previous year, as revealed by the Centers for Disease Control and Prevention (CDC), the prevalence of syphilis has been on an upward trajectory, nearly every year since its nadir in 2001.

This escalation is not confined to the United States; in the United Kingdom, for instance, 2023 witnessed the highest infection rate in half a century, according to David Mabey, BCh, DM, of the London School of Hygiene and Tropical Medicine. Additionally, he emphasized that syphilis and other sexually transmitted infections pose significant challenges in low- and middle-income nations, although comprehensive data are often lacking, according to Medspace.

In light of this, numerous contemporary healthcare professionals lack substantial exposure to the ailment, as noted by Ina Park, MD, an expert in sexually transmitted infections at the University of California, San Francisco. Reflecting on her own experience, Park asserted, “A whole cohort of medical practitioners, including myself, encountered no instances during our formative years of training. We find ourselves in a significant period of catch-up.”

A Condition Spanning Centuries

Addressing the complexities associated with diagnosing this elusive infection at the 2024 Annual Meeting of the Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Park distilled her advice to a simple directive: “Test, test, test!”

Additionally, syphilis’s camouflaging qualities make it possible to look like different diseases, as well as to enter so-called hibernation. That can cause even experienced doctors to leave syphilis unnoticed or give less accurate results, as per Medspace.

Ms. Jones’s focus on the updated FCD screening recommendations regarding syphilis screening cannot be denied, she underlined. Of all nation-dwellers, every sexually active individual aged 15 to 44 living in cities over 4.6 per 100000 prevalence of syphilis must be checked. Besides, the doctor reminded medical staff to stay alert whenever there exists the slightest chance of occurrence of the disease, even with lower incidence rates. In a sexually active patient case, testing should be the first move to make if the patient experiences new symptoms, as recommended by the doctor.

Navigating Complexities

The dearth of familiarity with syphilis extends beyond diagnosis to treatment, particularly concerning intricate cases, observed Khalil Ghanem, MD, PhD, from the Johns Hopkins University School of Medicine in Baltimore. He remarked, “When an ailment remains dormant for an extended period, one’s acumen in managing it may diminish.”

At the CROI, Ghanem proffered strategies for addressing challenging scenarios involving ocular syphilis, otic syphilis, and neurosyphilis, as well as interpreting perplexing test outcomes indicating erratic antigen titters.

In instances of suspected ocular or otic syphilis, Ghanem advocated for immediate referral to the emergency department, bypassing the customary consultation with specialists like ophthalmologists, owing to the risk of irreversible complications such as permanent blindness or deafness. “Procrastination is ill-advised in such circumstances,” he cautioned, as per the reports by Medspace.

Close monitoring of a patient’s rapid plasma regain and venereal disease research laboratory antigen levels is indispensable for managing syphilis and assessing treatment efficacy, Ghanem emphasized. However, he acknowledged that interpreting these titers can pose challenges, with instances where they deviate unexpectedly post-treatment.

To decipher enigmatic test results, Ghanem underscored the importance of obtaining a comprehensive patient history to discern potential reinfection risks, signs of neurosyphilis or other complications, pregnancy status, and other pertinent factors. “Based on this information, one can devise the most judicious treatment approach,” he mentioned.

Shortage Dilemmas

Efforts to curb the spread of syphilis have been further complicated by supply shortages. Last summer, Pfizer announced the depletion of stocks of penicillin G benzathine (Bicillin), a long-acting injectable crucial for syphilis treatment, particularly in pregnant individuals. Pediatric supplies were exhausted by June 2023, followed by adult stocks by September.

Given Pfizer’s monopoly on penicillin G benzathine production, interim solutions are scarce, prolonging the shortage until at least mid-2024. Consequently, the US Food and Drug Administration has temporarily authorized the use of benzylpenicillin benzathine (Extencilline), a French formulation not approved in the United States, until supplies stabilize.

This shortage underscores the critical need for alternative syphilis treatments during pregnancy, which is essential for mitigating the risk of congenital syphilis. Ghanem expressed hope that this predicament would spur the National Institutes of Health and other stakeholders to expedite research into alternative therapies suitable for pregnant individuals.