Syphilis has historically been associated with promiscuity, afflicting famous personalities like Oscar Wild, Beethoven and King George IV. But despite the general decrease in all STIs since the 1990s, syphilis is on the rise. And with an increase in infections across all demographic groups, syphilis has again become a ‘public health concern’.
Syphilis has a long history of being stigmatised, often being branded with shame and thought of as a disease of the lower classes, even despite its presence amongst members of the aristocracy. But this stigma is a key factor contributing to the recent rise. Labelled a ‘silent epidemic,’ it is thought that sufferers often remain in secret in fear of public reaction, consequently limiting partner notification. In this way, syphilis can spread within a cluster of individuals without any formal diagnosis or medical intervention. And this has been seen in several geographical hotspots, especially in London.
This reluctance to seek medical attention presents a significant problem as secondary and tertiary symptoms can present from weeks to years after initial infection. These include lesions in the skin, bones and central nervous system. In contrast, primary syphilis presents as painless ulcers that can be easily treated with antibiotics. But even this requires that the patient notices the ulcer. And even then, they can often be misdiagnosed by non-STI specialist services. GPs have received widespread criticism for leaving symptoms undetected. And a poor understanding of the signs and symptoms of syphilis is responsible for significant delays in diagnosis.
Public Health England has recognised the increase in an action plan published in 2019, with emphasis on sustained targeted health messages, especially to individuals more at risk. This refers primarily to “men who have sex with men” (MSM), who saw a disproportionate 75% increase in diagnosis. This effort aims to heighten public awareness of the symptoms and causes, whilst also dissolving the taboo around syphilis itself. The creation of a safe medical environment where patients feel safe to receive treatment is essential to reducing outbreaks but this is difficult in a cultural landscape that so heavily stigmatises the disease. And with fear mongering language common in articles around the subject, this stigma seems unlikely to break anytime soon.
Technology is also having an impact. With the proliferation of dating apps, the way people meet has changed dramatically. Platforms like Tinder and Grindr have been cited as causing an increase in infections. However, this technology is also helping to combat the disease by enabling partner notification. And whilst it is easier for people to meet new partners, such apps have also created an easy delivery route for partner notification and social campaigns around prevention.
By engaging in conversation, we render the subject of syphilis and STIs ordinary, and sufferers are less likely to feel alienated by their own community. A wider understanding of routes of transmission and treatment for everyone eases the sociological tension around the subject. This will only lessen the disdain many people feel towards syphilis, and in turn, decrease the number of silent sufferers. Nevertheless, the fact is that until we reach a point where our media and medical bodies see sexual health on par with our overall health and mental wellbeing, there will not be a safe environment for positive patients to come forward.