Syphilis is back. The potentially deadly sexually transmitted disease which came close to being eliminated in the West over the past 25 years is resurgent again, and it is catching doctors out.
In high-income countries, cases of the disease that killed Gaugin, Baudelaire and Toulouse Lautrec are soaring. In the UK, it has jumped from 307 cases in 1997 to 3,702 in 2006, an increase of 1,200 per cent.
"Huge" increases have been recorded in cities including London, Dublin, Berlin, Paris and Rotterdam, say specialists at the Centres for Disease control in Atlanta, Georgia. Rises have also been registered in the US, Canada, Australia and New Zealand.
The rise is being driven, in the main, by men who have sex with men. In the late 1980s and 1990s, fears about HIV led sexually active young people, heterosexual and gay, to exercise greater care over sex partners, what they did with them in bed, and condoms. But the arrival of antiretroviral drugs against HIV led to the perception that it was a treatable disease and caused young people to drop their guard, leading to rapidly rising rates of all sexually transmitted disease, including syphilis. In the UK, increases started in the cities and then spread outwards to suburban towns and rural areas.
In the journal, Lancet Infectious Diseases, Kevin Fenton and colleagues from the Centres for Disease Control say the demographics of the disease have changed dramatically over 30 years in the US, shifting from gay men to poor, black heterosexual crack addicts and back to gay men again. Since 2000, the rise has continued unabated driven by the use of Viagra and amphetamines, saunas, circuit parties and the internet, "all of which influence sexual mixing patterns and increase transmission risk".
Syphilis is transmitted by sex. It requires contact with the lesions of a person who has active primary or secondary syphilis and transmission occurs in about half of such cases. Up to six weeks after infection, a primary lesion develops, usually on the genitals but it can be anywhere on the body at the point of contact. It is called a chancre and is normally a hard, painless skin ulceration.
Secondary syphilis is caused by the multiplication of treponemes – parasites that cause the disease – which spread throughout the body and can cause fever, headache and rash on the palms and feet. The disease can then remain latent for many years, in some cases for the rest of the victim's life, or it may develop into tertiary syphilis invading the brain and causing death.
The disease, which can also be transmitted from mother to baby, can be treated with antibiotics but the authors say doctors lack the experience to deal with it. They write: "The recent resurgence among men who have sex with men and some high-risk heterosexual couples raises cause for concern and demands renewed vigilance among, and training of, health professionals."Reuse content