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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
The writer is a contributing columnist, based in Chicago
Celebrated people down the ages have contracted syphilis, one of the world’s oldest sexually transmitted diseases. But when the local clinic called to give a young friend the news that his test was positive, his first reaction was: who gets syphilis these days? What is this, the reign of Henry VIII (long suspected to have been a sufferer)?
The harried nurse had no time to mollycoddle him: “there’s an epidemic of syphilis in this area [the south side of Chicago] and so we routinely test everyone,” she told him. He needed treatment and his sexual partners had to be tested too.
The young man wants to remain nameless, because syphilis is about as socially acceptable today as it was under the Tudors. But he eventually learnt (though not before some tough talk from his live-in girlfriend) that he was a false positive.
Many Americans are not so lucky: syphilis cases in the US are at their highest level since 1950. In newborns, “congenital” syphilis — which can cause miscarriages, stillbirths, or life-long medical problems — was up more than tenfold between 2012 and 2022, according to the US Centres for Disease Control.
And it’s not just a US problem: syphilis cases in England are at their highest since 1948 and the World Health Organization estimates that globally 7.1mn people between the ages of 15 and 49 contracted the disease in 2020.
Of the more than 3,700 American babies born with syphilis in 2022, nine out of 10 cases could have been prevented, says the CDC. More than half were born to mothers who tested positive during pregnancy but didn’t get adequate or timely treatment. Nearly 40 per cent involved those with no prenatal care.
“We are going backwards when it comes to infectious diseases in the US, and a lot of it has to do with structural racism,” says Dr Marcelo Venegas, a regional medical director at the AIDS Healthcare Foundation. His organisation has put up billboards in 30 media markets including Chicago since December, warning mothers that “syphilis can be fatal to your baby”.
The CDC says the burden of syphilis is falling most heavily on non-whites: in 2021, babies born to black, Hispanic or native American mothers were up to eight times more likely to get newborn syphilis than white babies. Non-white mothers often can’t take time off work or get childcare to go to the doctor, may not have health insurance or don’t live in areas where medical care is easily accessible, CDC experts say.
But the US is also the victim of its own past success, says Dr Robert McDonald, medical officer in the CDC’s division of sexually transmitted disease prevention. “In the late 1990s, we were really close to eliminating it,” he told me. “But that means most of our medical community didn’t learn about syphilis as an active problem”. Many public STD clinics disappeared, making it harder to get tested and treated and this was exacerbated by the Covid pandemic, STD experts say.
Changing sexual habits have played a big role in the current epidemic, says Dr Khalil Ghanem, syphilis expert at Johns Hopkins School of Medicine and a past president of the American Sexually Transmitted Diseases Association. Before cases fell to their lowest recorded levels in 1999, he told me, “HIV was a death sentence, so people had fewer sexual partners, there was more abstinence and more people used condoms.” But with widespread use of antiretrovirals to treat HIV, sexual behaviours loosened up again and, from 2000, syphilis cases rose, he says.
Syphilis is now so widespread among the heterosexual population that one of the biggest risk factors is geography, not behaviour: according to the CDC, more than 70 per cent of the US population live in counties with high rates of the disease. That’s why everyone under the age of 65 is routinely tested at the University of Chicago hospital emergency room — no matter why they came in — says Dr Kimberly Stanford, an ER physician.
“The great thing about syphilis is that it’s extremely treatable,” she says. This isn’t the 16th century and penicillin easily defeats the disease. But first you must know that you have it. In today’s America, too few of those who are most at risk have any way of finding that out.
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