A newly published report from the Armed Forces Health Surveillance Center (AFHSC) reveals a marked and continuous increase (49.1% overall) in crude syphilis incidence rates during the period between 2010 and 2014, and an increase in primary and secondary syphilis in active duty military members that mirrors trends reported in the civilian population as a whole.

Treponema pallidum spirochete/CDC

In the AFHSC report, which looked at a surveillance period of 1 January 2010 through 31 August 2015, found a total  of 2,976 cases of syphilis diagnosed. Crude incidence rates increased from 30.9 cases per 100,000 person-years (p-yrs) in 2010 to 47.4 cases per 100,000 p-yrs through August 2015.

Like in the civilian population, men contributed the greatest proportion of syphilis cases (88.7%) during the period, and incidence rates for males increased every year of the surveillance period. Female rates of syphilis were highest in 2014 at 34.0 cases per 100 000 p-yrs.

1,253, or 42 per cent of cases were specifically identified as primary or secondary syphilis; crude incidence rates of primary and secondary syphilis cases increased every year since 2011. Syphilis cases staged as latent accounted for an additional 27.1 per cent (n=809) of cases; cases where the stage was unspecified comprised another 670 (22.5 per cent) cases.

Overall, syphilis rates were highest in those service members aged 20-29 years; these age groups accounted for 61.6 per cent of the total number of cases ascertained. The overall incidence rate in black, non-Hispanic service members was twice that of Hispanics, who had the 2nd highest overall incidence rate of syphilis.

Nearly 25 percent of syphilis cases (727) also were diagnosed as HIV seropositive; of these, 601 were diagnosed with HIV infection prior to contracting syphilis and the rest were diagnosed as HIV seropositive after syphilis diagnosis.

The authors say the increasing incidence of syphilis in military members is of significant public health concern because this finding suggests that some service members have been engaging in unsafe sexual practices that increase the likelihood of acquisition of other sexually transmitted infections (including HIV); however, they do list several limitations to the study.

They close saying: There have been multiple hypotheses posited for the resurgence of syphilis in the civilian population: among these are decreases in safer sex practices; increased use of the Internet as a means of meeting sexual partners; and the increase of harm reduction strategies such as oral sex, which can decrease the risk of HIV transmission but conversely increase the risk of contracting syphilis.

Several of these sexual risk behaviors have been documented as being increased in Army service members who are HIV seroconverters. Developing and implementing syphilis prevention measures targeting service members at high risk of acquisition should continue to be promoted as well as continuation of aggressive sexual partner notification programs.

Syphilis is an STI caused by the bacterium, Treponema pallidum. The most common way to get syphilis is by having sexual contact (oral, genital or anal) with aninfected person. The secondary lesions are also infective and contact with them could transmit the bacteria. It can also be transmitted from an infected motherto her baby (congenital transmission).

Syphilis goes through four stages that can overlap:

Primary Syphilis

The first symptom of primary syphilis is frequently a small, round, firm ulcer called a chancre (pronounced “shanker”) at the place the bacteria enters the body (usually the penis, vulva or vagina, but it may appear on the cervix, tongue or lips). There is usually just one chancre, however there can be many. Swollen lymph nodes in these areas are common.

The chancre usually appears in about 3 weeks after infection, but can occur anytime from 9-90 days after infection.

Because chancres are painless and can occur inside the body, you may not notice it. It disappears after 3-6 weeks whether you are treated or not. If primary syphilis goes untreated, it then moves into the secondary stage.

Secondary Syphilis

The most common symptom of this stage is a non-itchy rash. The rash is usually on the palms of the hands  and soles of the feet, it can cover the whole body or only a select few areas. This occurs 2-10 weeks after the chancre heals. Other common symptoms are sore throat, fatigue, headache, swollen glands and less frequently hair loss and lesions in the mouth.

Much like primary syphilis, secondary syphilis will disappear even without treatment. If untreated it goes into the latent and tertiary stages.

Latent Syphilis

This is the hidden stage of syphilis. At this stage there are no symptoms. This stage can last for weeks or decades.

Early latent syphilis is still an infectious stage and you can transmit the disease to your partner. In late latent syphilis, the risk of infecting a partner is low or absent.

Signs and symptoms may never return or if untreated it goes into the most serious stage, tertiary syphilis.

Tertiary Syphilis

Even without treatment only a minority of infected people develop these horrible complications. In this stage, the bacteria will damage the heart, eyes, brain, bones, joints and central nervous system. This can happen decades after the initial infection. This can result in blindness, deafness, memory loss, heart disease and death. Neurosyphilis is one of the most severe signs of this stage.

Congenital syphilis can results in miscarriages, premature births and stillbirths. Some infants with congenital syphilis have symptoms at birth, but most develop symptoms later. Sore on infected babies are infectious so holding and kissing infected babies could transmit the disease.

It is very easy to detect early stages of syphilis through blood tests that detect antibodies.

It is easy to treat syphilis in the early stages with one injection of Penicillin. Later stages or neurosyphilis may take daily doses given by IV in a hospital. It is important to note in late syphilis, any damage done to organs cannot be reversed.

Having a syphilis chancre can increase the transmission of HIV up to 5-fold.

To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex:

• Avoid sex, or have mutually monogamous sex with one partner who is uninfected.
• Talk with your sex partners about your HIV status and history of other sexually transmitted infections.
• If you don’t know the STI status of your partner, use a latex condom with each sexual contact.
• Avoid excessive use of alcohol or other drugs, which can cloud your judgment and lead to unsafe sexual practices.

Robert Herriman is a microbiologist and the Editor-in-Chief of Outbreak News Today

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