The State of Syphilis in Springfield

By Stephanie Woehl, Coordinator of Communicable Disease Prevention at Springfield-Greene County Health

When people think of sexually transmitted diseases, syphilis, a bacterial infection spread through sexual contact, doesn’t usually come to mind. This may be because syphilis was nearly eliminated in 1957 after the introduction of a national Sexually Transmitted Diseases (STD) program and antibiotic penicillin. Just a little over 20 years ago, cases of syphilis reached historic low infection rates in 2000–2001.

But fast forward to now and syphilis has made a resurgence in over 30 states across the country, including Missouri. The number of early syphilis cases reported in Missouri increased by 259% from 2015 to 2021. Even more significant is the recent increase in congenital syphilis in Missouri. Congenital syphilis occurs when a pregnant person with untreated syphilis passes the infection to the baby during pregnancy.

An increase in ocular syphilis, which can cause blurry vision and/or blindness, is also occurring.

A recent health update from The Missouri Department of Health and Senior Services tells us that cases have been steeply increasing in smaller metropolitan areas and rural counties. Greene County can be considered part of those areas due to its increase in cases.

Provisional data shows syphilis cases in Greene County have increased twelve-fold from 2015 (20 cases) to 2022 (262 cases).

The rise in cases is alarming not only because of the number of cases, but because of the impact syphilis can have on the body.

During any point of infection, syphilis can impact the nervous system, eyes, and a person’s hearing ability. In cases of congenital syphilis, miscarriages can occur as well as premature births, stillbirths, or death of a newborn child. A child born with congenital syphilis can experience serious health complications at their time of birth or later in life.

Syphilis can become fatal in a person if left untreated for a long period of time.

It’s important to be aware of the signs, symptoms, and prevention methods for this infection in order to keep yourself and your sexual partner(s) safe and healthy. I am here to help answer your questions about syphilis, how it spreads, and prevention methods you can take.

How does it spread?

Syphilis is spread through direct person-to-person contact with a syphilitic sore, called a chancre. Chancres are painless and appear at the spot where the bacteria entered your body, which means these can occur on or around the penis, vagina, anus, rectum, lips or mouth. While they usually appear as a single sore individuals can have more than one. Syphilis can be spread by having anal, oral, or vaginal sex with someone who currently has syphilis.

A pregnant person can also spread syphilis to their unborn child.

How do I know if I have syphilis?

It can be difficult to determine if you have been infected with syphilis because the symptoms of this infection are very similar to other diseases. A syphilis infection typically happens in a progression of stages that can take place over a series of weeks, months or years. The three stages of a syphilis infection are the primary, secondary, and latent stages.

The Stages of Syphilis

Primary Stage: During this stage a chancre (usually a round, hard, painless bump) will appear on the location of the body where the syphilis infection entered the body. The chancre will remain on the body for 3–6 weeks and heal on its own with or without treatment. Despite a chancre healing, this does not mean that a person no longer has syphilis. Without treatment, the syphilis infection will progress to the secondary stage.

Secondary Stage: The secondary stage of a syphilis infection typically begins with the development of a rash on various parts of the body. These rashes can have the following characteristics:

• Can appear where syphilitic sores (chancres) are healing or where these sores had healed
• Usually do not cause itching
• May appear as rough, red, or reddish-brown spots on the palms of the hands or the bottoms of the feet. Other types of rashes resembling those of other diseases may appear on other parts of the body
• May be so faint that they are difficult to notice

The secondary stage can also cause large, raised, gray or white legions on moist areas of the body, such as the mouth, armpit, or groin area. Additional symptoms of the secondary stage include:

• Fever
• Swollen lymph nodes
• Sore throat
• Patchy hair loss
• Headaches
• Weight loss
• Muscle aches
• Fatigue

All the symptoms listed in the above section will go away with or without treatment. However, without treatment this infection will progress to the latent or tertiary stage.

Latent Stage: This stage of infection is also called the “hidden” stage because this period of infection has no visible signs or symptoms of syphilis. There are two different categories within this stage of infection: Early Latent Syphilis and Late Latent Syphilis.

• Early Latent Syphilis: Latent syphilis where the infection occurred within the last 12 months.
• Late Latent Syphilis: Latent syphilis where the infection occurred more than 12 months ago, and the exact infection date is unknown.
• Latent syphilis can remain in the body for years.

Who can get syphilis?

Any person having anal, vaginal, or oral sex with an individual who has tested positive for syphilis is at risk for infection. According to the CDC, men who have sex with men and men who have sex with both men and women accounted for about 43% of all primary and secondary syphilis cases in 2020; however, the number of heterosexual individuals testing positive for syphilis is increasing.

Is syphilis treatable?

Yes! When caught in the primary, secondary, or early latent stages syphilis for adults who do not have HIV or are pregnant, syphilis is treatable with the use of a single dose of penicillin. Individuals with late latent syphilis can be treated with penicillin shots at weekly intervals. Syphilis affecting the nervous system, eyes, or hearing can be treated with more extensive penicillin treatment for a period of 10–14 days.

What happens if I don’t treat my syphilis?

Untreated syphilis can progress into Tertiary Syphilis. This is a very serious stage, although rare, which can begin after several years of having untreated syphilis. Tertiary Syphilis can affect multiple organ systems, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Depending on what organ is affected by Tertiary Syphilis, symptoms can vary. This form of syphilis can be fatal.

Prevention strategies:

It is important to empower ourselves with accurate information regarding sexual health in order to stay safe and healthy. Misinformation around STIs and STDs can cause fear and make discussing these topics with sexual partners feel uncomfortable. You can prevent getting or passing syphilis by consistently using condoms or dental dams during sex and/or by engaging in a sexual partnership where both people have tested negative for syphilis. Syphilis can be passed by physical contact with sores that are not covered with a condom, but regular STI/STD testing can ensure that you are made aware of an infection before potentially spreading the infection. Additionally, chancres that are present in the vagina, rectum, and mouth can be asymptomatic and make it difficult for you or your sex partner to even know if either are positive for syphilis.

Regardless of your relationship status, if you are sexually active it is important to schedule STI/STD testing on a regular basis as this can help reduce the spread of syphilis.

If you’re interested in being tested for syphilis, Springfield-Greene County Health offers STI Testing to the public every Monday and Wednesday, excluding holidays, from 8 a.m. — 2 p.m. and by appointment only on Tuesdays at 227 E. Chestnut Expy. Walk-ins are available but we recommend calling 417–864–1684 to ensure space is available. Testing is also offered for chlamydia, gonorrhea, trichomoniasis, HIV, mycoplasma genitalium, and Hepatitis B.

Stephanie Woehl is a Master’s prepared registered nurse and Coordinator of Communicable Disease Prevention for Springfield-Greene County. She oversees the epidemiology program, vaccination clinic services, tuberculosis clinic, and the Disease Intervention Specialist (DIS) program. Stephanie has been with the City of Springfield since 2015.