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Syphilis has re-emerged as a significant public health threat in recent years. While most cases of syphilis are currently diagnosed in low-income and middle-income countries, the incidence of syphilis has been increasing in Western industrialised countries since the 1990s, particularly among gay, bisexual and other men who have sex with men (MSM).1 Increased rates among heterosexuals in these countries have also been reported in more recent years, most often in marginalised populations.2 In England, there were 7982 diagnoses of syphilis during 2019, a 200% increase since 2010. Although three-quarters of cases were diagnosed in MSM, cases in heterosexual men and women have increased by 69% and 117%, respectively, between 2015 and 2019, and the number of cases of congenital syphilis (CS) has also increased.3 The underlying drivers of the increase in heterosexually acquired syphilis cases in England remain unclear.
Syphilis is caused by Treponema pallidum subspecies pallidum and is typically transmitted by direct contact with an infectious lesion during sexual intercourse. The clinical presentation of syphilis is divided into three stages, primary, secondary and tertiary, and the first two are the most infectious stages. Typically, primary syphilis presents as a painless ulcer (chancre) which usually occurs in genital sites and resolves within 3 to 8 weeks. If left untreated, 25% of patients will develop secondary syphilis, a systemic disease characterised by fever, rash and lymphadenopathy. Secondary syphilis will resolve spontaneously in 3 to 12 weeks and all untreated cases will progress to latent (asymptomatic) infection, with …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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