It seems that syphilis is on the rise again. More and more people are becoming infected by this sexually transmitted disease.
“In the yere of Chryst 1493 or there aboute this most foule and most grievous disease beganne to sprede amonge the people,” a German scholar named Ulrich von Hutten wrote soon after the first known outbreak of syphilis swept across Europe.
Today, syphilis can seem like a historical relic, more likely to appear in period movies than in one’s next-door neighbor. But after more than a decade of increases in syphilis cases, the United States is looking at its highest rate in recent memory.
According to a report released on November 17 by the Centers for Disease Control and Prevention, syphilis rates rose for both genders in every region of the U.S. in 2014. The rate of reported primary and secondary syphilis (the earliest symptomatic stages of the disease) increased by 15.1 percent from 2013 to 2014, to 6.3 cases per 100,000 people. The rate of reported congenital syphilis (passed by an infected mother to her child during pregnancy) increased by 27.5 percent, to 11.6 cases per 100,000 live births.
Syphilis had become relatively rare in developed countries since the discovery of penicillin, though it continues to plague many parts of the global South. At the turn of the millennium, it looked as though the United States had all but eliminated the disease. After an outbreak in the early 1990s, diagnoses of primary and secondary syphilis had dropped to 2.1 cases per 100,000 people—the lowest rate since the U.S. began recording it in 1941. But in 2002, the downward trend began to reverse.
The new wave of syphilis shows no signs of slowing down. In New Orleans, the number of syphilis cases tripled between 2012 and 2014. Central New York, which two years ago reported 27 syphilis cases, most recently reported 110, and some health clinics are now offering free syphilis testing. Health officials in Oregon, where syphilis rates have increased by more than 1,000 percent from 2007 to 2014, have created a new website syphaware.org. The site’s homepage reads, “Oregon is known for many things: natural beauty, coffee, beer, and Pinot Noir. Did you know that Oregon is also known for syphilis?”
Researchers are still trying to work out why these increases are happening now, but the CDC’s report offers a few clues. For one, syphilis isn’t the only sexually transmitted disease becoming more common. Syphilis, chlamydia, and gonorrhea—the three STDs that comprised the focus of the report—rose simultaneously for the first time on record, which suggests an underlying cause that isn’t syphilis-specific.
Some health officials point to the growing role of technology in people’s sex lives, specifically apps like Tinder and Grindr that facilitate casual sex between partners who don’t know each other’s sexual histories. But there’s no conclusive evidence that these apps have played a role in syphilis outbreaks, especially given that Tinder was released more than a decade after syphilis rates began rising again in 2002.
Sarah Kidd, an epidemiologist at the CDC, believes dating apps can pose a diagnostic problem, since controlling the spread of syphilis relies on being able to notify an infected person’s sexual partners.”We do know that with the rise of so many apps, it’s easier to meet partners and not necessarily have identifying information and not be able to track them down later,” she says.
Compared to chlamydia and gonorrhea, syphilis is particularly challenging from a public-health perspective because most Americans don’t think of it as a threat.
Some historians believe that Columbus and his crew brought the infection from America upon returning to Europe, though that theory was challenged just last week when researchers found signs of congenital syphilis in the skeleton of a European child who died in the 14th century.
Syphilis has afflicted some of the West’s most famous cultural icons. Vincent Van Gogh, Franz Schubert, and Robert Schumann had it; so did Charles Baudelaire, Gustave Flaubert, Oscar Wilde, and Friedrich Nietzsche. Ludwig van Beethoven, Wolfgang Mozart, and James Joyce all had symptoms of what may have been syphilis, according to some researchers. Al Capone had the mental capacity of a 12-year-old child when he died at 48, the result of dementia from neurosyphilis. Shakespeare’s plays and poetry are littered with allusions to syphilis: “the pox,” “the infinite malady,” “the malady of France,” “the incurable bone-ache.”
Syphilis is not the mysterious disease it once was. We know that it spreads when someone else comes in contact with the sore, most often during penetrative or oral sex. And we know that syphilis is completely curable with penicillin, though penicillin won’t erase any damage the infection has already caused. The problem is identifying it in the first place—the symptoms of syphilis often mimic those of other diseases (which explains why, over a century ago, syphilis earned the nickname “the great imitator”). It’s entirely possible to go through the early stages of the infection without knowing it.
Because syphilis can be difficult to prevent and to recognize, the CDC is encouraging sexually active people, especially pregnant women and men who have sex with men, to get regular syphilis tests.