BY MELISSA PATRICK
KENTUCKY HEALTH NEWS
As cases of syphilis continue to increase across the nation and in Kentucky, the announcement of a new at-home syphilis test that was recently approved by the U.S. Food and Drug Administration is timely.
“The rise in syphilis infection rates is a serious and alarming public health concern,” Dr. Armaghan-e-Rehman Mansoor, an infectious disease specialist with UK HealthCare, told Kentucky Health News in an email.
Nationwide, the Centers for Disease Control and Prevention reports syphilis cases increased by nearly 80% between 2018 and 2022. In Kentucky, the state Department for Public Health reports an increase of 77% between 2020 and 2022.
Syphilis is one of the most common sexually transmitted infections, or STIs, in the United States. It is caused by a bacteria that spreads with vaginal, anal and oral sex with someone who has the infection. It is treatable with an antibiotic.
If left untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness and paralysis.
Also of great concern is the rate of congenital syphilis is on the rise.
“Another alarming concern is the rate of infection in newborns, who can have transmission of syphilis in the uterus,” Mansoor said. “In the same time period of 2020 to 2022, Kentucky has seen a 169% increase in syphilis infection in newborns.”
Newborn syphilis happens when people do not receive timely testing and treatment during pregnancy. The CDC reports that 40% or two in five people who had a baby with syphilis did not get prenatal care. Syphilis during pregnancy can cause miscarriage, stillbirth, infant death or lifelong medical issues.
Mansoor noted that while there are many ways to obtain syphilis testing, including primary care offices, health departments, student health at universities and infectious diseases specialists, barriers to health care can prevent people from getting tested in a timely manner. He called this new, over-the-counter, at-home syphilis test that can deliver results within 15 minutes a “breakthrough in reducing such barriers.”
“In a coordinated public health response to the syphilis epidemic, this is a very important tool in timely screening and treatment, which can help reduce the spread of infection in our communities,” he said. “If people do have a positive test, they should seek treatment as soon as possible. . . . It would also be recommended to consider screening for other STIs during this visit.”
That’s because people with syphilis can be at risk for other STIs such as gonorrhea and chlamydia.
“People should know that there is a similar at-home test available for gonorrhea and chlamydia that was approved in 2023,” he said.
Mansoor also stressed that if a person’s at-home syphilis test is negative, but they continue to have STI symptoms, they should seek testing through a medical provider as soon as possible.
Further, he said the at-home test does not differentiate whether the positive test result is for a new syphilis infection or a prior infection, even if it was successfully treated, so it’s important to see a medical provider for any positive test result.
CNN reports that biotech company NOWDiagnostics Inc. said the test, called First to Know, will be available before the end of this year and is expected to cost $29.98
Early symptoms of syphilis
“Early symptoms of syphilis can include a new rash which can also involve the palms and soles, ulcers that can be painless or painful in the mouth or genital area, and pain, irritation or drainage from the genital region,” Mansoor said.
He said it’s important to get tested for syphilis even with no symptoms.
“Syphilis is different from other STIs because while most people will notice one or more early symptoms after infection, the symptoms can resolve on their own without treatment,” he said. “However, the syphilis bacteria continue to remain in the body and can cause devastating complications even months or years later.”
Because of this, he said it is very important for people to get screened as soon as any symptoms occur and to consider STI screening after unprotected intercourse with new partners even in the absence of symptoms.
“Syphilis can impact people in every age group, ethnicity, gender and location of residence, which is why a coordinated public health response at the local, state and national level is important,” he said.
Why is syphilis on the rise?
Asked why he thought there continues to be an upward trend in syphilis cases, Mansoor said, “Multiple factors are likely contributing to this dramatic rise, including individual concerns such as delays in recognizing symptoms, difficulty in seeking timely medical care, and substance use disorders.
“There are also systemic factors that can become barriers to recognizing and treating STIs such as syphilis. These include difficult access to the nearest healthcare facilities that can offer screening and treatment, and a decrease in public awareness of when screening should be obtained and what common symptoms of sexually transmitted infection can be.”
Reducing the risk
The CDC says the best ways for sexually active people to reduce the chances of getting syphilis are to be in a long-term mutually monogamous relationship with a partner who has been tested and does not have syphilis and to use condoms the right way every time you have sex.
Mansoor added that prophylactics, such as Doxy PEP and PREP, can reduce exposure risk to syphilis and other STIs.
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.