Rise of Syphilis as Health Emergency – Asrar Qureshi’s Blog Post #1035

Rise of Syphilis as Health Emergency – Asrar Qureshi’s Blog Post #1035

Dear Colleagues! This is Asrar Qureshi’s Blog Post #1035 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing our contributions here.

Credit: Andrea Piacquadio

Credit: Korhan Erdol

Credit: Marcus Vinicius

Preamble

While browsing through various health-related sites, I was struck by the information on the rise of syphilis as a health emergency in some parts of US and Europe. Upon further search, I found alarming facts which I am sharing here. As you will see in the following text, the factors causing the disease are also quite prevalent in Pakistan, and I shall share available data on syphilis prevalence here.

Facts about Syphilis

• Syphilis is sexually transmitted infection (STI) caused by a bacterium Treponema pallidum. The disease spreads through all forms of sexual intercourse, and through blood transfusion. 

• Syphilis in pregnancy may lead to stillbirth, newborn death, and babies born with congenital syphilis. Babies born with syphilis can experience rashes, organs inflammation, anemia, bone and joint problems, neurological conditions including blindness, deafness, meningitis, and seizures, and developmental delays.

• Many people with syphilis do not have symptoms or do not notice them.

• Rapid tests can provide results in few minutes, which can allow immediate treatment. Further lab tests are also available. 

• Syphilis is treatable and curable. First line of treatment is benzathine penicillin injections. Second line treatment may include doxycycline, ceftriaxone or azithromycin. 

• In 2022, WHO estimated that 8 million adults aged 15-49 acquired syphilis. Significant increase was seen among men who have sex with men.

• 700,000 congenital syphilis cases were also estimated globally, leading to 150,000 early fetal deaths and stillbirths, 70,000 neonatal deaths, 55,000 preterm or low-birth weight births, and 115,000 infants with clinical diagnosis of congenital syphilis.

• Without treatment, the tertiary phase of syphilis may lead to several complications decades after infection. At that stage, it can affect multiple organs and systems, including brain, nerves, eyes, liver, heart, blood vessels, bones, joints, and can also cause death.

Syphilis Resurgence in Europe

The number of syphilis cases climbed between 2015 and 2022. Malta had the highest rate of the countries with available data at 24.4 cases per 100,000 population in 2022. This was followed by Luxembourg (23.4), Spain (16.6), Lichtenstein (15.3) and Portugal (14.8). However, Romania and Bulgaria bucked this trend where the number of cases dropped drastically.

Syphilis Resurgence in the United States

According to a new report from the Centers for Disease Control and Prevention – CDC, syphilis cases increased by nearly 80% to more than 207,000 between 2018 and 2022. 

Rates increased among all age groups, including newborns, and in all regions of the country. In 2022, 3,755 cases of babies born with syphilis were reported, which reflected an alarming 937% increase in the past decade. Racial and ethnic minorities are most disproportionately affected due to long standing social inequities.

Experts point to various reasons for the increase, including in substance abuse tied to risky sexual behavior, decrease in condom use, ongoing social and economic conditions, and reduction in STI services at the state and local level. 

Syphilis in Pakistan

Various studies on different groups are available. However, most are dated and there is no consolidated data to read the overall picture.

A cross-sectional-study conducted at different healthcare hospitals of Punjab, aimed to evaluate the prevalence and risk factors associated with syphilis in blood donors. 1,200 samples were collected from donors aged 18-65 years; personal data was collected via structured questionnaire. Prevalence of syphilis was 3.91% or 3,900 cases per 100,000, a very high number.

A study to establish prevalence of STIs in Faisalabad, Pakistan reported this. Syphilis was present in 29.5% of 1,532 patients attending STI clinics, gonorrhea in 13%, and Chlamydia in 4.7%. Opposite sex partners were preferred by 63% patients, while 30% had both homosexual and heterosexual partners. 

A study on the prevalence of syphilis among antenatal clinic attendees in Karachi reported this. The prevalence of confirmed syphilis was 0.5% in a sample size of 800 women from three urban sites. Women who lived in an area where male drug use was prevalent, had 1.5% incidence.

A study from Fatima Jinnah Medical College Lahore assessed the profile of men suffering from STIs in four capital provinces of Pakistan. 465 men suffering from STIs were interviewed. Their ages ranged from 20-40 years. 60% were married, 58% lived in urban areas, and 82% lived with families. Only 10.5% were drug addicts. Out of 465 cases, 32% had syphilis, 27% gonorrhea, and 18% herpes. 55% men acquired STI heterosexually, 12% through homosexuality, and 18% through bisexual relations. The main source of acquiring STI heterosexually were sex workers. None acquired infection though his wife. 

The data from Pakistan is still sketchy and incomplete, however, it points out to serious prevalence all the same. 

Sum Up

STIs (also called STDs) are a serious health hazard. STIs are among the most common cause of illness in the world and have far reaching health, social and economic consequences. In addition to their sheer magnitude, STIs are a major health problem for two additional reasons: their serious late complications, and the fact they facilitate transmission of HIV. 

Since the subject is taboo in Pakistan, the patients tend not to report the disease, or they go to unqualified practitioners who give them treatments which may may make them suffer more.

Being a taboo subject, the awareness campaigns are non-existent. HIV AIDS was a prohibited topic few years ago, and the public and government vehemently rejected the idea of any HIV AIDS patient in Pakistan. Gradually, the reality has sunk that there are several patients here. The problems caused by this attitude are that proper statistics are not available, the magnitude of problem remains unclear, and policy making cannot be done to tackle the issues.

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

References:

https://www.who.int/news-room/fact-sheets/detail/syphilis?gad_source=1&gclid=Cj0KCQiAo5u6BhDJARIsAAVoDWu0ONNCxzVZ6JQKELfT75xBLNI3qa73CEM2Jy2PqTIxY3-3JqyxRNoaAlfaEALw_wcB

https://www.statista.com/chart/31739/eu-cases-of-gonorrhoea-syphilis-and-chlamydia/#:~:text=As%20the%20following%20chart%20shows,)%20and%20Portugal%20(14.8).

https://www.npr.org/2024/01/31/1228195107/syphilis-cases-soar-in-us-cdc-says#:~:text=Over%20the%20past%20year%2C%20there,year%20old%2C%22%20said%20Finley.

https://www.researchgate.net/publication/354117230_Prevalence_and_risk_factors_of_Syphilis_among_blood_donors_of_Punjab_Pakistan

https://www.researchgate.net/publication/51175208_Sexually_transmitted_infections_in_Pakistan

https://pmc.ncbi.nlm.nih.gov/articles/PMC3574871/

https://ayubmed.edu.pk/JAMC/PAST/15-2/Rehan%20STD.htm