Rare, acute symptoms of syphilis increasingly appearing in Chicago patients, study finds

Chicago doctors reported in a recent study a change in the number of people who contract syphilis and experience the rare and alarming symptoms of the infection. The change comes as syphilis cases continue to rise nationally and prompts the city’s public health experts to call for more effective and widespread screening.

The symptoms—headaches, vision and hearing problems, and even mental changes—are collectively called syphilis NOO, for neurosyphilis, ocular syphilis, and otic syphilis. According to the study, presented last month at the Epidemic Intelligence Service 2024 conference in Atlanta, Chicago health care providers are now seeing cases of syphilis that do not have typical early symptoms, such as sores. or rashes, but instead show signs of syphilis. NOO syphilis.

Study co-author Dr. Amy Nham, a CDC official and epidemiology researcher at the Chicago Department of Public Health, told the Chicago Sun-Times that public health officials are still figuring out exactly why this change had occurred, but the results demonstrate the need for health care providers to perform better and more widespread syphilis screening.

“We are seeing an increase in syphilis across the country,” Nham said. “There may also be an increase in the number of untreated or insufficiently treated patients, a situation made worse by the shifting of resources during COVID. And untreated syphilis infections could lead to more serious outcomes.

Cases of NOO syphilis are rare; researchers identified 28 such cases in Chicago between January and August 2023. (According to the Chicago Department of Public Health, there were 806 cases of primary and secondary syphilis in 2022.) Nineteen, or 68%. , “did not present typical symptoms of syphilis”. says the study.

But the results are remarkable because they show who is affected. The patients ranged in age from 23 to 82, and 75% were men and 71% were black, according to the study. Black men are generally more affected by syphilis than white men, according to data from the Centers for Disease Control and Prevention.

Only one in three patients were HIV positive, which is significant because NOO syphilis is often seen among people living with HIV, according to the study. And 54% of the patients studied were heterosexual men, while about 20% identified as gay. NOO syphilis typically affects men who have sex with men, or MSM, according to the study and the CDC.

“We need a change of message”

Dr. Irina Tabidze, director of the Office of Syndemic Infectious Diseases at the city health department, said the development in NOO syphilis cases is part of a broader increase in syphilis infections, most notable among women and heterosexual men. For years, there have been strong public health messages about STIs aimed at men who have sex with men, she said, including the benefits of PrEP, a preventative medication. against HIV. But there hasn’t been much emphasis on STI prevention among the heterosexual population.

“We need a change in the message,” Tabidze said. “We need to develop more targeted messages for the heterosexual population so that they know that… syphilis does not only affect MSM, but also the heterosexual population.”

Tyler Pasciak LaRivière/Sun-Time

“Clinicians should consider syphilis NOO even in people without typical signs and symptoms of syphilis and in people without HIV,” the study recommends.

All syphilis cases in the United States jumped 80% between 2018 and 2022, according to the CDC, although cases increased in Illinois by 28% during the same period. Cases of congenital syphilis, where a baby is born with the disease, have also increased in recent years.

Dr. Michael Angarone, an infectious disease specialist at Northwestern Memorial Hospital, said the Center for Infectious Diseases has seen manifestations of syphilis in recent years “that we don’t typically see at first,” such as syphilitic eye disease or syphilis. ‘hepatitis. These are usually associated with the second stage of infection, he said.

Angarone added that the atypical symptoms may be partly attributed to patients who have not reached the early stages of syphilis and then seek medical attention when more visible problems arise.

Syphilis infections usually develop in stages, according to the CDC. Each stage may have different signs and symptoms. It is caused by bacteria after direct contact with a syphilis sore called chancre, which usually develops in the first stage.

“Early manifestations of syphilis can sometimes go unnoticed, so when you have chancre it may be painless and you may not know you have it, or it may be in an area of ​​the body where you don’t “I don’t recognize the presence of something,” Angarone said.

Cankers can last 3 to 6 weeks, the CDC said. A rash may develop during the second stage in addition to sores. Other symptoms of the second stage include weight loss, fever, muscle pain and hair loss.

These symptoms may go away on their own without treatment, but that doesn’t mean the infection is gone, the CDC said. Without treatment, syphilis can persist in the body for decades. If left untreated, it can spread to the brain and nervous system, the most serious forms of the infection. And since providers shifted to telehealth appointments during the pandemic, it’s harder for doctors to detect early syphilis if they don’t examine patients in person, Tabidze said.

Angarone said it’s important for people to get tested, even if they don’t have any symptoms, noting that syphilis can also be asymptomatic. The infection can be cured with antibiotics, but treatment may not be able to reverse the damage done if it is allowed to spread.

“We need to find better ways to encourage people to get tested, and everyone to get tested, so that we can identify as many cases of syphilis as possible and be able to treat them,” he said .