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Syphilis cases on the rise in Hawaii, health department says

                                Darkfield micrograph of Treponema pallidum, the spirochaete bacterium that causes the disease syphilis.
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Darkfield micrograph of Treponema pallidum, the spirochaete bacterium that causes the disease syphilis.

The rate of syphilis cases in women and newborn infants in Hawaii is on the rise, according to the state Department of Health. It has been on the rise every year over the past four years.

“While we know everyone’s current attention is focused on preventing the spread of COVID-19, we must also pay close attention to syphilis because of the potential health effects, especially for developing babies,” said Dr. Glenn Wasserman, chief of the department’s Communicable Disease and Public Health Nursing Division, in a news release. “Syphilis is preventable and easily treatable when diagnosed early.”

Officials said early cases of syphilis, a sexually transmitted infection, in adults are particularly infectious, while later stages of the disease can lead to significant damage to numerous organs, including the heart and brain.

Pregnant mothers with syphilis can transmit the disease to their unborn fetus at any stage, causing miscarriage, stillbirth, prematurity, low birth weight or death before or shortly after birth. In addition, babies born with syphilis can have deformed bones, severe anemia, and other problems.

In Hawaii, the number of babies born with syphilis — known as congenital syphilis — ranged from zero to two cases per year from 2000 to 2016, increased to three to four cases per year from 2017 to 2019, and is now at 11 probable cases so far in 2020.

Health officials say the more recent rapid rise of cases in women and now, of congenital syphilis, reflects an increasing trend that requires immediate attention.

“All sexually active women with risk factors for sexually transmitted infections (STIs) should be regularly tested for syphilis and other STIs,” Wasserman said. “We are now recommending that pregnant women with risk factors for STIs be tested as early as possible during the first trimester, at 28 to 32 weeks of gestation and again at the time of delivery. It is also important that sexual partners are also adequately treated to prevent women from becoming re-infected.”

Men account for most cases of syphilis, with most cases occurring among men who have sex with men, officials said.

Hawaii is focusing on prevention, early identification and treatment as the number of syphilis cases increase.

The health department is asking health care providers to be vigilant for cases of syphilis in women and during pregnancy. It is urging providers to follow recommendations for diagnosing and treating cases, including the treatment of partners to prevent re-infection and providing follow-up care for patients and infants.

Diagnosing syphilis can be tricky as signs of infection may not be apparent, officials said, especially during latent phases of infection.

In the primary stage, the patient often experiences one or more chancres — which are firm, round, and painless sores — at the original site of infection. Signs of secondary syphilis may include a skin rash, swollen lymph nodes, and fever, while in the latent stage, there are no signs or symptoms.

The infection progresses in stages that can last for weeks or several years.

Screening for syphilis requires two different types of tests, and the reinfection of pregnant mothers may be difficult to identify.

More information is available at this link.

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