Rates of syphilis infection are climbing across the U.S. and in Spokane County, drawing concern from public health officials.
Historically, Spokane County has had fewer than 10 cases of infectious syphilis reported each year, Spokane Regional Health District disease interventions specialist Kirsten Duncan said.
In 2015, that baseline nearly tripled to 28 cases. Data from 2016 isn’t finalized yet, but Duncan said the number is higher than 2015.
“We don’t quite have a good handle on why that’s happening yet,” she said.
Nationally, 7.5 out of every 100,000 Americans had syphilis in 2015, compared to the lowest documented rate of 2.1 per 100,000 in 2001, according to the CDC.
Rates of syphilis infection among gay and bisexual men are more than 100 times the rate among heterosexual men, according to a CDC report published last week. In Washington, 306 of every 100,000 gay or bisexual men had syphilis, compared with 1.9 of every 100,000 heterosexual men.
Though gay and bisexual men make up a majority of cases, Duncan said rates of infection are increasing faster among heterosexuals in Spokane.
Perhaps even more than with other sexually transmitted diseases, people who have syphilis often don’t realize they’re infected. The first stage of the disease is a very contagious lesion, called a chancre, appearing at the site of infection.
The lesion can be small and is easily missed if it’s in the mouth or covered by hair.
“Because they’re painless, people just kind of write them off,” she said.
Without treatment, syphilis progresses to its second stage, which can include rashes on hands and feet, mucous patches in the mouth and infectious genital warts.
After that stage, some people will never experience symptoms again. But for others, it enters a tertiary stage, often years later. That can cause serious health concerns.
“What’s scary about that with syphilis is when it goes untreated, it can cause deafness, blindness, paralysis, even death,” said Kaleb Ashby, a sex educator who formerly worked for the Spokane AIDS Network.
That’s why health workers are especially concerned about syphilis, even though chlamydia and gonorrhea remain more common.
Most health care providers do not screen heterosexual people for syphilis unless they specifically request it, Duncan said. An initial infection can take up to 90 days to show up on a blood test.
The good news is syphilis is easily treatable with penicillin if it’s caught in the first or second stage.
Using condoms for all sex acts can prevent the spread. Duncan said syphilis can be passed during oral sex, and the infection can begin in the mouth or throat.
Ashby said decreased fear of contracting HIV, the virus that causes AIDS, has led some people to stop using condoms. Pre-exposure prophylaxis drugs, which significantly reduce one’s chance of getting the virus, do not prevent any other STDs.
Among straight people, he said, there’s a lingering perception that syphilis is a disease mostly affecting gay men, and thus not something they have to worry about.
“There is almost a mindset of invincibility,” he said.