Doctors warn they’re seeing syphilis patients with unusual and severe symptoms


Disease detectives In Chicago, there is a worrying trend: patients are complaining of unusual symptoms such as vision and eye problems, headaches and hearing loss or dizziness caused by syphilis, a sexually transmitted infection.

Doctors have long known that syphilis can permanently damage a person’s vision and hearing and can even lead to psychiatric changes, but these symptoms are usually associated with infections that have not been diagnosed or treated since. years.

In a new study presented Wednesday at the Epidemic Intelligence Service 2024 conference in Atlanta, researchers say there were more than two dozen cases with these types of symptoms in Chicago last year, and nearly A third of cases were in the early stages of their development. infections.

More than two-thirds of these patients (68%) did not have typical symptoms of syphilis, such as a rash or chancre, that could alert doctors to the infection.

“Providers definitely need to do more screening tests and be aware that this is what we are seeing,” said study lead author Dr. Amy Nham, who is a first-year EIS officer, or “ disease detective,” assigned to the Chicago department. Public health.

Syphilis cases are increasing in the United States. In 2022, more than 207,000 cases of syphilis have been reported, the highest number since the 1950s, according to the U.S. Centers for Disease Control and Prevention.

Men who have sex with men have traditionally suffered the most from syphilis in the United States, and this is still true; But in recent years, the demographics of infection have changed and infections have more than doubled among heterosexual men and women since 2019. Congenital syphilis, where the infection is passed from a pregnant woman to her baby, is also increasing.

Nham said his supervisors at the Chicago Department of Public Health asked him to review cases with unusual symptoms — called NOO syphilis, for neurosyphilis, ocular syphilis and otic syphilis. – after learning that city providers were seeing more.

She searched a citywide medical records repository for cases of patients with signs or symptoms consistent with NOO syphilis and 28 people matched her case definition. Most (75%) were male and Black (71%). The patients were aged 23 to 82 years. Six were gay men, but about half identified as heterosexual. One in three people were HIV positive, which is a lower percentage than Nham expected, given that people with HIV typically have more severe syphilis symptoms. According to the latest CDC data, more than a third of gay men with primary and secondary syphilis were also HIV positive.

Nham’s study found that the most common symptoms experienced by patients were headaches, personality changes or altered mental status, as well as eye problems such as vision loss, sensitivity to light or swelling of the eye.

“These are not the most specific symptoms, That’s why it’s very important for providers to do proper screening and ask patients about risk factors, and things like their sexual history, Nham said.

Syphilis is caused by a bacteria called Treponema pallidum. The infection progresses in stages. People get it when they come into contact with a round, firm, painless sore called a chancre, which usually appears on the genitals, lips or tongue. The chancre marks the first stage of infection. These sores can last 3 to 6 weeks and may eventually go away on their own, without treatment. Sometimes people don’t notice them because they are small or in a hard to see place.

Syphilis is a sneaky infection. Its symptoms come and go and can resemble many other illnesses, leading doctors to nickname it “the great imitator.”

Once the chancre is gone, the infection may appear to be gone, but it has just been hiding. The second stage of infection usually begins with rash or sores in the mouth. People generally don’t feel well: they may have fever, swollen lymph nodes, fatigue, sore throat, muscle pain, hair loss, and weight loss.

Syphilis can progress to a third stage if left untreated. The third stage appears 10 to 30 years after the initial infection and can be fatal.

At any time during infection, the bacteria can invade the nervous system, causing damage to the brain, eyes and ears. This can include things like headaches, swelling of the brain called meningitis, strokes, and mental changes. The eyes may be sensitive to light or swollen, or vision may be affected. People may also experience hearing loss, dizziness or tinnitus if the infection reaches their ears.

Nham’s study focused only on Chicago, but she collected case reports and says doctors are seeing similar phenomena in other parts of the country.

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She said she doesn’t know for sure why they’re seeing more cases with these atypical symptoms — it was beyond the scope of her study — but she has a few theories.

The preferred treatment for syphilis is an injection of a long-acting form of the antibiotic penicillin, called Bicillin LA, which has been in short supply for the past year.

Since injections are the only effective treatment during pregnancy, the CDC has advised health care providers to prioritize these injections for pregnant people and babies.

Men can take another antibiotic – doxycycline – to treat their infections. But doxycycline is a pill that must be taken twice a day for several weeks to be effective, and some people don’t complete the entire course of treatment, which can allow their infection to fester and get worse.

“There could simply be an increase in the number of untreated or insufficiently treated patients, leading to more serious consequences of syphilis,” Nham said.

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