DISEASE ‘detectives’ have spotted worrying new trend in people suffering with early stages of syphilis, who reported vision and hearing loss.
It’s not unheard of for the 15th century sexually transmitted infection (STI) to damage people’s eyesight or hearing if it’s gone untreated for years.
2
But new research presented at the 2024 Epidemic Intelligence Service Conference in Atlanta claims syphilis sufferers are reporting these typically late-stage symptoms in the early stages of their illness.
Chicago-based researchers said 28 people reported these kinds of symptoms in the city last year and nearly a third of them were in the early stages of their infection.
On top of this, more than a third of these patients (68 per cent) hadn’t experienced other symptoms typically caused by syphilis, like rashes or sores on their genitals or mouth, as reported by CNN.
Doctors often use these kinds of symptoms to spot if someone has syphilis, so it was worrying to researchers that some patients weren’t getting them.
“Providers definitely need to be screening more and be aware that this is what we’re seeing,” said Dr Amy Nham, lead study author and one of the “disease detectives” assigned to the Chicago Department of Public Health.
Syphilis is an STI that can cause serious health problems if goes untreated.
It typically spreads via direct skin-to-skin contact, according to the NHS, most commonly through unprotected vaginal, anal or oral sex with someone who is infected.
But it can also be passed on to an unborn baby during pregnancy, which is referred to as congenital syphilis.
Syphilis was rife during medieval times, with an epidemic erupting in Europe in the mid-1490s.
It remained a significant medical problem until the mid-20th century, with medical advances leading to better treatments and a dramatic drop in case numbers.
Sadly, this wasn’t the last we saw of the 15th century STI, as cases have increased in the last few years.
Recent government figures showed that syphilis diagnoses in England surged to their highest level since 1948 following trends seen in the US, where the disease reached highs not recorded since the 1950s.
Meanwhile, the World Health Organization estimated that 7.1million adults aged 15 to 49 acquired it globally in 2020.
In the US, men who have sex with men have historically been most affected by syphilis.
But infections in heterosexual men and women have more than doubled since 2019, with congenital syphilis also on the rise.
Dr Nham was tasked with examining syphilis cases with unusual symptoms – known as neurosyphilis, ocular syphilis, and otic syphilis or NOO syphilis – after Chicago health providers flagged their were noticing an uptick.
After combing through medical records dated between January and August 2023, she identified 28 people with NOO syphilis, 75 per cent of them men and 71 per cent Black, aged between 23 and 82.
About half said they were heterosexual, while six of them were gay men.
One in three of the patients (32 per cent) were HIV-positive.
Dr Nham said she’d expected more of them to be so, as having HIV can make syphilis symptoms more severe.
Symptoms of syphilis and its stages
THE symptoms of syphilis are often mild, making them difficult to spot.
They also tend to change over time, and come and go, so it is easy to presume you aren’t infected, even when you are.
The most common symptoms of the infection include:
- Small sores (ulcers) on your penis, vagina, or around your bottom (anus) – these are usually painless and you may only have one of them
- Sores in other areas, including in your mouth or on your lips, hands or bottom
- White or grey warty growths most commonly on your penis, vagina or around your anus
- A rash on the palms of your hands and soles of your feet that can sometimes spread all over your body – this is not usually itchy
- White patches in your mouth
- Flu-like symptoms, such as a high temperature, headaches and tiredness
- Swollen glands
- Patchy hair loss on the head, beard and eyebrows
These signs may not appear until three weeks (or more) after you’re infected.
Sometimes the symptoms can improve or go away completely, but if you have not been treated the infection is still in your body.
This means you can still pass it on and you’re at risk of getting serious problems later on.
Potential complications include:
- Heart problems like angina, aortic aneurysm and heart failure
- Brain problems like fits (seizures), memory problems, personality changes and dementia
- Nerve problems like shooting pains, pins and needles, joint pain and gradual damage the joints
- Problems with the skin, bones, testicles, liver and any other organ
Syphilis tends to happen in stages.
- Primary stage – between two to 12 weeks after exposure (patients develops painless sores on the genitals that might heal on their own)
- Secondary stage – between one to six months after the primary stage (patients may develop itchy rashes on the skin)
- Latent stage (patients show no signs but remain infectious)
- Tertiary stage (patients may develop complications)
Some of these problems may not appear for many years after being infected with syphilis.
At any point in the infection, syphilis bacteria – Treponema pallidum – can invade the nervous system and affect the brain, eyes or ears.
This may cause headaches, brain swelling, strokes, and mental changes.
Eyes may become sensitive to light or swollen, or sight may be affected and people may also experience hearing loss, dizziness, or tinnitus if the infection reaches their ears.
Source: NHS, WHO, CDC
Nineteen of the 28 patients didn’t have typical syphilis symptoms like chancre sores or rashes.
The most common symptoms patients experienced were headaches, personality changes or altered mental status, and eye problems like vision loss, sensitivity to light or eye swelling.
“They’re not the most specific symptoms, which is why it’s really important that providers are doing appropriate screening and asking patients for risk factors,” Dr Nham said.
The study only zeroed in on syphilis cases in Chicago, but Dr Nham said she’d been collecting case reports from other parts of the US and said doctors are seeing similar trends in other parts of the country.
She speculated that the rise in atypical symptoms could be due to shortages of syphilis treatments in the US.
The preferred treatment for syphilis, an injection of long-acting penicillin called Bicillin L-A, which has been in short supply for a year.
Dr Nham warned: “There could just be an increase in untreated or inadequately treated patients, which is leading to more severe outcomes of syphilis.”
It comes after a cluster of eye syphilis infections was reported in Michigan, after five women slept with the same man.
In the UK, doctors were warned to be on the lookout for syphilis in all pregnant women under new NHS guidelines, after medics flagged “increasing number of diagnoses” of the medieval STI in both expectant mums and unborn babies.
Experts syphilis can be treated if caught early, but it can be serious and potentially life threatening in the long-term if it isn’t caught.