Syphilis: A silent epidemic reawakens

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In a recently published article Indian Dermatology Online Journal, researchers studied the epidemiological and clinical profile of Indian patients who visited a tertiary care center for treatment of syphilis. Their findings indicate that although there are effective treatments for syphilis and the disease is preventable, the number of cases worldwide has increased over the past decade. Effective prevention and treatment are needed to ensure that untreated cases do not lead to adverse health outcomes that have implications for public health.

Study: Syphilis: Is it back with a bang?  Image credit: Kateryna Kon/ShutterstockStudy: Syphilis: Is it back with a bang? Image credit: Kateryna Kon/Shutterstock

About the study

In this study, researchers followed a cross-sectional observational design to assess the epidemiological and clinical profile of people with syphilis receiving treatment at a sexually transmitted infection (STI) specialist clinic between 2019 and 2021. Patients of all ages and sexes were included if they had clinically diagnosed syphilis, including latent, primary, secondary, tertiary, and congenital.

In the clinic, staff records patients’ complete clinical histories and performs general physical, systemic, and mucosal examinations. Clinical photographs were taken, and rapid plasma reagent (RPR), Treponema pallidum hemagglutination assay (TPHA), and screening for human immunodeficiency virus (HIV) were performed.

Patients were diagnosed as having syphilis based on serology, clinical features, and history. Latent syphilis was diagnosed in those with no clinical signs and symptoms but positive serology at screening. A patient is also tested if mixed venereal disease is suspected.


In total, 1,330 people sought care at the clinic, of whom 200 (144 men and 56 women) received a diagnosis of syphilis. The mean age of the patients was 30.9 years, and the majority were between 21 and 30 years of age.

Male patients were mainly manual laborers or long-distance drivers, while about 90% of female patients were housewives. Based on the modified Kuppuswamy Socio-Economic Scale, most belong to upper-lower classes.

In terms of marital status, 63% were married, including 53 women and 73 men; More than 40% of women showed positive RPR serology and were antenatal. About 20% of male respondents reported being bisexual or homosexual.

Half of the respondents reported a history of premarital or extramarital contact, and 36% said they had engaged in sexual contact with paid sex workers. About 30% were polygamous, and about 85% reported that they had engaged in unprotected sexual activity.

About 25% of patients had primary chancre, 44.5% had secondary syphilis, 30.5% had latent syphilis, and only 0.5% had congenital syphilis (a two-day-old girl with no clinical manifestations). Tertiary syphilis was not observed in the study. Chancers were found on the tongue and uvula, while 43 patients had rashes on different parts of the body. In addition to syphilis, 25 had herpes genitalis, 7 had genital molluscum contagiosum, 10 had cancroid, and 6 had concurrent genital warts. Screening suggested that 5 females and 28 males among 200 patients were HIV-positive and had positive RPR titers.


Although effective treatment is widely available, syphilis continues to have a high prevalence and has seen a resurgence in India and other countries. Comparison with previous studies indicates an upward trend in syphilis cases.

The predominantly male patient group may be due to their involvement in more risky behaviors and because they are more likely to seek treatment early. At the same time, women are limited by cultural and social stigma and are more likely to be asymptomatic. Early initiation of sexual activity, if not accompanied by safer practices, can be a risk factor for STIs.

Although other studies have found strong associations between STIs and low education, which limits self-care ability and understanding, the majority of patients in this study were educated.

Drivers and daily wage workers who migrate to find work appear to be a high-risk group because they spend long hours away from their partners, which leads to risky sexual behavior. Findings also indicate the need to target commercial sex workers to promote safer behaviors to reduce the growing burden of STIs.

Rates of infection and re-infection may also be higher among men who have sex with men with HIV – this group can be targeted with interventions to reduce stigma around their condition, bring them closer to health services and improve their quality of life.

There is an urgent need to limit the spread of STIs through rapid diagnostic kits, sex education and safe sex education. High-risk groups can be targeted in a cost-effective way. Most importantly, stigma surrounding STIs must be addressed to ensure prevention and effective treatment.

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