Current Situation:
In 2022, there were a total of 4,416 cases of confirmed syphilis in Washington state. This number continues to rise statewide, doubling or tripling every year since 2020. There has been a corresponding increase in our region.
What Does Syphilis Look Like?
Syphilis occurs in several different stages. These are:
- Primary Infection: usually marked by a single painless sore (chancre) at the spot where syphilis entered the body. This is a highly infectious stage, and the disease will progress without appropriate treatment.
- Secondary Infection: often includes skin rashes and mucous membrane patches or lesions. May also include fever, flu-like symptoms, swollen lymph glands, sore throat, patchy hair loss, headaches, and weight loss. Without treatment, this can progress to latent, tertiary or neurosyphilis.
- Latent Syphilis: individuals are asymptomatic but continue to carry the bacteria in their body. If untreated, this can persist for the rest of the person’s life and can progress to Tertiary Syphilis at any time.
- Tertiary Syphilis: this stage is when the disease begins damaging internal organs such as the heart, blood vessels, brain and nervous system and can be fatal.
- Neurosyphilis: can occur during ANY of the above stages. Symptoms include headaches, vision changes, hearing loss or tinnitus, vertigo, neuropathic pain and cognitive effects.
In addition, there are specific risks to individuals who are or may become pregnant:
- Congenital Syphilis: A pregnant person infected with untreated syphilis can pass the disease to the baby during pregnancy. These infants can have a wide range of health complications and can be born stillborn or die early in infancy.
If You Suspect Syphilis – Actions Requested:
Test:
- Patients being tested for gonorrhea and/or chlamydia should also be tested for syphilis and HIV.
- We recommend ensuring your STI testing panel include syphilis and HIV, especially in pregnant people. All sexually active individuals are at risk for contracting syphilis and should be tested at least annually.
- Individuals with a diagnosis of any STI (including HSV), a history of substance use, unstable housing situations, a history of incarceration in the last 2 years, or engaging in transactional sex are at higher risk of syphilis. These individuals should be offered additional screening up to every 3 months.
- Be familiar with the common symptoms of primary and secondary syphilis and have a low threshold of suspicion for syphilis if patients have rashes, oral or genital lesions, or wart-like growths in the rectal or genital area.
Treat:
- Treat the patient within your clinic. If you are having trouble accessing treatment, contact the health department for assistance. JCPH has Bicillin available to transfer to providers.
- According to the WA DOH Office of Infectious Disease, there are no official supply shortages of bicillin at the moment. There can be temporary shortages and delays due to high demand. However, it is important to treat primary and secondary syphilis with bicillin whenever possible to prevent progression to latent syphilis.
Counsel:
- Educate patients about safe sex practices. Patients should be counseled to use a barrier method during all sexual activity until at least 7 days after being treated and until sores have fully healed and symptoms have resolved.
- Free safe sex materials are available at Jefferson County Public Health at 615 Sheridan St in Port Townsend.
Report:
- Make sure to fill out a case report and call Jefferson County Public Health (360-385-9400, ask for the CD team) with questions or concerns, even if the confirmatory test is pending.
Resources For Providers:
WA DOH Syphilis Provider Resource: https://doh.wa.gov/public-health-provider-resources/notifiable-conditions/syphilis
WA DOH Syphilis Fact Sheet, including information on testing, treating, and reporting: https://doh.wa.gov/sites/default/files/legacy/Documents/5000/347-656-SyphilisReportingGuidelines.pdf
Syphilis Screening Algorithm – American Medical Association: Clinical algorithm flowchart for syphilis screening https://www.ama-assn.org/system/files/routine-screening-clinical-workflow-algorithm-syphilis.pdf
Blank STI Case Reporting Forms (Jefferson County): https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/347-102-JeffersonCsRpt.pdf?uid=63ee933264506
Syphilis is Back: a resource for patients and community members: https://www.syphilisisback.com/