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Rising Syphilis Cases In The US Is A Women's Health Crisis
TW: please be aware we’ll be discussing pregnancy, trafficking and child death in this piece.
This week’s hot topic over the lunch table at HANX HQ? Trends in sexually transmitted infections (yes, we’re considered a riot at parties). Right now in the US, we’re seeing a worrying rise in syphilis. It might sound like a Victorian affliction but cases of this sexually transmitted infection have increased 80% since 2018 across all age groups. When it comes to women’s health, it’s having an especially catastrophic impact, especially on those who are pregnant. So, why is this STI flourishing across the States right now? HANX’s in-house OB/GYN and sexual health expert, Dr Sarah Welsh, dives into the rise of syphilis, especially in women, and how to stay safe.
How do I know if I have syphilis?
Syphilis is transmitted primarily via vaginal, anal or oral sexual activity without a condom. One of the challenges in stopping the transmission of this sexually transmitted infection is that symptoms of syphilis can be mild, change over time, and are often hard to notice. Symptoms can include small, painless sores on the genitals, anus, or other areas, as well as flu-like symptoms, swollen glands and a rash on the palms of hands, and soles of feet. However, some people may not experience any symptoms at all - and that is a big problem. Without regular STI screening that includes syphilis (not all testing does!), a lack of symptoms means it can pass on without being picked up, causing broader health complications for more people.
Why is it so important to treat syphilis?
If left untreated, syphilis can lead to serious or even life-threatening health issues such as damage to the heart and brain, blindness, deafness and paralysis. Whilst it does not directly cause infertility in women in the way gonorrhea or chlamydia can, syphilis increases the risk of miscarriage or stillbirth if you’re pregnant - and real risks to infants who contract it, too.
Why are seeing a rise in syphilis in the US?
The rise in syphilis kicked off massively in 2000 and is continuing to climb. In fact, a report by the Centre of Disease Control and Prevention shows a shocking 80% increase in diagnosis between 2018-2020. It’s being driven by a whole host of factors including:
- lack of symptoms. Where a growth, rash or unusual discharge may push patients to seek medical care, many people follow a ‘no symptoms, no problem’ mindset, leaving the condition undiagnosed, untreated and ready to spread through sexual contact.
- dating app culture. This isn’t to demonise hookup culture at all. Dating apps offer increased sexual contact with a broader range of partners carries an increased risk, especially if proper precautions to protect against STIs aren’t taken.
- lack of comprehensive sex education. We need to educate, empower and equip young people all across the US to advocate for their sexual health. This is tricky in a country which does not have a national standard for sex education. In fact, 17 US states still provide abstinence-only sex education, all of which boast a higher than average rate of teen pregnancy. Open, honest and informed discussion about the risks of unprotected sex is proven to have a positive impact on young women’s lives.
- decreased condom use. Blame it partially on poor sex ed, but fewer Americans are using condoms than previously. It’s been suggested that not only is this down to abstinence-focused sex education, but also a rising stigma around condoms, for instance, their impact on sensitivity and pleasure for men.
- increased substance use/chemsex. Having sexual encounters whilst drunk or feeling the effects of drugs is becoming increasingly normalised, but it can also remove inhibitions and increase the likelihood of risky behaviour. This can make it more likely to make rash decisions in the heat of the moment and not use barrier contraception, such as condoms. For instance, when it comes to syphilis rising in the US, the CDC has pinpointed meth abuse as a key contributor.
- The most significant impact, however, is likely lack of funding for sexual health services. We’ll dive into that below…
Why are women especially affected?
When it comes to routine STI testing, many clinics are restricted financially in terms of the services they are offering. Where sexual health screening is offered, syphilis isn’t always tested for and essentially can fly under the radar. This means that whilst some women are getting regular STI screens during their annual exams, they’re only getting the all-clear for more common conditions such as gonorrhea or chlamydia.
Additionally, some individuals at higher risk for STIs (including women and people who exchange sex for drugs or money) do not have access to proper healthcare, with many sexual health clinics being closed in recent years. Whilst increased healthcare coverage may be broadening access to STI care, at a local level, clinics are simply closing or reducing key services due to lack of budget. At a personal level, the cost of STI care in the US can also be majorly prohibitive, pushing away those who need treatment or preventative care. Equally, many women who do manage to access healthcare do not always finish the course of treatment due to socioeconomic inequalities, lack of trust in the medical sector and trafficking.
Pregnancy is a particularly vulnerable life stage for women, especially at which to have syphilis. Declining access to prenatal care, and the prohibitive costs, make it less likely for syphilis to be picked up and treated - this used to be a key touchpoint for diagnosis. Without treatment, this can lead to congenital syphilis, where the infection is most often passed onto the fetus in utero, or through direct contact with a syphilis sore on the vagina during childbirth. Sometimes, a healthy baby is carried to term, but congenital syphilis can cause major health problems, including prematurity, miscarriage, stillbirth. It can also cause fever, meningitis in the early days post-birth, and if not treated swiftly, can impact vision, hearing, cause developmental delays and more. Right now in the US, the CDC reports seeing 1 case of congenital syphilis for every 357 births - creating a huge challenge for the healthcare sector.
In essence, it’s a perfect storm: women are especially at risk due to a lack of comprehensive - and affordable - STI screening, poor sex education, partners who due to lack of symptoms or stigma around STIs are not getting tested - and stigma around condoms, too.
How do we tackle the rise in STIs, including syphilis?
Without adequate funding, we hit a steep climb to tackle the rise of syphilis. To combat this rise in cases, US healthcare experts are calling for a greater focus on prevention, rather than just treatment. This includes increasing public awareness of the infection, introducing multiple screenings for syphilis during pregnancy, making screenings more affordable, better education of healthcare professionals, and improving access to testing in institutions such as prisons. It is also important to address societal inequalities that may contribute to the spread of sexually transmitted infections, such as active outreach, support and free resources for those who are more at risk of syphilis.
With the US election build up in full swing, Kamala Harris has made reproductive rights and affordable healthcare a core focus of her campaign. Optimistic as we are, we believe that this could evolve to include greater funding for public sexual healthcare - and really help tackle the syphilis rise, amongst other pressing sexual wellness issues.
So, what can you do to protect yourself and others from syphilis?
- Get screened regularly for sexually transmitted infections, including requesting a syphilis check.
- Use barrier methods, such as condoms, during sexual activity to reduce the risk of transmission.
- Practice open and honest communication with sexual partners about your sexual health and history.
By taking these steps and advocating for improved sexual health services, it’s a start towards reducing the spread of syphilis - and its impact on women’s health.
Want more?
- Got an STI? Here’s our practical guide on how to tell your partner/s.
- Stock up on our sensitive, FDA-approved ultra-thin Condoms.
