Let us be serious about Syphilis: Lessons learnt from China to the Amazon
Syphilis is notorious as a disease that has caused serious outbreaks throughout history whether in times of war or peace. Many well-known historical figures suffered from the disease. Today syphilis still kills a baby every 2 minutes worldwide and infects millions of adults every year.
Syphilis is notorious as a disease that has caused serious outbreaks throughout history whether in times of war or peace. Many well-known historical figures suffered from the disease. Today syphilis still kills a baby every 2 minutes worldwide and infects millions of adults every year. Is this because we don’t know how to diagnose and treat it? No. We have simple, cheap diagnostic tests for syphilis which we have shown to be effective in significantly improving access to testing and allow the immediate administration of a single shot of penicillin to prevent mother-to-child transmission at even the most remote antenatal clinics from China to the Amazon forest.
Why then does syphilis remain a major public health problem in most of the world, and now with rising incidence in Europe and North America? This ancient scourge associated with poverty, sex and marginalization is seemingly still difficult to talk about. Syphilis seems to have been forgotten by policy makers, funding agencies and public health agencies in much of the world. Huge amounts of money have been given to HIV control programmes for the prevention of HIV transmission from mother to child, yet less than half of pregnant women are screened for syphilis in Africa. This lack of political commitment, stigma and neglect may also be related to the fact that syphilis can be a silent disease before it causes perinatal death or serious disability. We have learned that controlling syphilis is critical in controlling HIV transmission, and the extent of its neurological effects, especially among immune-compromised individuals, is becoming better understood even today.
Mother-to-child transmission of syphilis (congenital syphilis) is a public health problem that has been identified by the World Health Organization as a feasible target for global elimination, and has been prioritized by the Centers for Disease Control and Prevention as a winnable battle. The Sustainable Development Goals that have been endorsed by all WHO member states stress the importance of patient and community-centred approaches and strategies that leave no one behind, least of all women and children. Let us, in this new era of “bottom up” instead of top down approaches in global public health, advocate for a serious commitment to syphilis prevention before it kills more people. We wrote last year a piece in the Huffington Post on how to save nearly half a million lives this year in 15 minutes, because that is the time it takes to test a pregnant woman for syphilis and save her from having a still birth due to syphilis.
Today we can commit to using a single platform – quality maternal and child health services including testing for preventable infections to eliminate mother to child transmission of HIV, syphilis and hepatitis B. Tomorrow, we must search for strategies that can effectively address rising syphilis rates in men who have sex with men in an era of PrEP to prevent HIV. For the future, there is evidence supporting potential for a vaccine against syphilis.
To read more about syphilis, please go to Nature Reviews Disease Primers on syphilis: http://go.nature.com/2g4pYkq