Syphilis doubled in NZ since 2015
Leo Tolstoy. Frederick Delius. Vladimir Lenin. Al Capone. Idi Amin. And even possibly Adolf Hitler. Believe it or not, the common fact binding that diverse group of historical figures is syphilis. This sexually transmitted bacterial infection was so common in the
1800s and early 1900s, with outbreaks right across the world, that it was one of the leading causes of dementia in that era. The discovery of penicillin in the 1940s led to a rapid decrease in incidence, but not unfortunately to complete eradication.
Syphilis numbers have remained high in developing countries, because of poorer access to condoms and treatment options, but until recently countries like New Zealand, Australia and the UK could feel quite smug – an acute case of syphilis was a very rare thing indeed. Not so now.
Figures show that infection rates are increasing again, not to the levels that were seen centuries ago, but certainly to a level that is causing public health concerns.
In 2017, there were 470 new cases reported in NZ (a figure that has doubled since 2015), and it is likely that there are actually many more than that, as cases diagnosed and treated by GPs are often not included in these official statistics.
Most cases were found to occur in men who have sex with other men, but the infection rate from heterosexual contact is increasing too – this pattern of spread mimics what has occurred in the UK, and the age range seems to be similar too, with most cases occurring in
20- to 39-year-olds. Bigger cities are unsurprisingly associated with more cases, with Auckland and Wellington having the highest numbers.
Although compared to the thousands affected by other infections, such as might happen during a flu outbreak, this may not seem to be much of a concern. But syphilis can be really hard to recognise, and hence treat – in fact, it used to be called The Great Mimicker as it could present in so many different ways, copying other diseases.
The longer it remains untreated, the greater the risk of it being passed on – it can remain infectious in the body for around two years after the initial infection, so if multiple sexual partners are exposed to an ‘‘index’’ case over that time period, it is easy to see how rapidly a small outbreak could grow into something much more worrying.
Add to this the fact that syphilis infection actually facilitates or enables transmission of HIV between individuals, and that it can be passed to babies in the womb, and it becomes even clearer why the Ministry of Health is concerned.
Syphilis infection typically has three distinct stages (although just to be confusing, some people can have syphilis and be infectious, but have no symptoms at all themselves):
Primary infection – within two to three weeks of having sexual contact with someone who has syphilis, an ulcer forms at the site of infection.
This ulcer is known as a chancre. It is usually, but not always, painless, and there are often enlarged lymph nodes near the site of the chancre.
Chancres occur most commonly on the penis, but can also be found on female genitalia, anus, mouth and even fingers. If left untreated, these lesions will resolve on their own within four to six weeks.
Secondary syphilis – without treatment, 25 per cent of people will go on to develop secondary syphilis, a few weeks or even months after the primary chancre appears. This tends to be more widespread in the body with a typical rash affecting the palms, soles and face, as well as general malaise and headaches.
In some cases, liver, kidneys and joints can be affected as well. Most cases of secondary syphilis resolve within three to six weeks, but unfortunately 80 per cent will go on to have ‘‘latent’’ syphilis which means they have positive syphilis blood tests, but no current symptoms.
In a smaller number, this can flare up later in life, causing tertiary syphilis – the most serious stage.
Tertiary or late stage syphilis can have devastating effects on the brain, heart, bones and skin.
Tertiary syphilis is very rarely seen in developed countries now due to the effective use of antibiotics earlier in the course of the disease, but is certainly not uncommon in other parts of the world where antibiotics are scarcer.
So if you or someone you know falls into a ‘‘higher risk’’ group (they are a man who has sex with men, they have multiple partners, or have recently had a change in partner and haven’t been using condoms) then you should be thinking about syphilis.
Yes, it is much less common than other STIs such as chlamydia or gonorrhoea, but the latest figures suggest that we could be on the brink of a significant outbreak, and the sooner cases are detected, the easier it is to prevent spread of not only this particular infection, but also HIV as transmission of the two is closely linked.
Use a condom every time if you do have a change in partner, or partners, and ask your GP or local sexual health clinic if you want to get tested – it is a simple, free blood test and the peace of mind it gives you will be well worth it.
The latest figures suggest that we could be on the brink of a significant outbreak.
❚ For more information, visit justthefacts.co.nz
❚ Dr Cathy Stephenson is a GP and mother of three.