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Bill Klaproth (Host): Syphilis is on the rise. So exactly what is it? Are you at risk? What happens if it goes untreated and how is it treated? So let's learn more with Ciara Shank, Certified Nurse Midwife, UPMC Obstetrics and Gynecology Specialists in North Harrisburg.

This is Healthier You, the podcast from UPMC in central Pennsylvania. I'm Bill Klaproth. Ciara, thank you so much for your time. It is really nice to talk with you and a topic that I think a lot of people say to themselves, I know what syphilis is, but do you really? And do you know what happens if it goes untreated? So, again thank you for your time So, let me start right with this just so we have a clear understanding of this Ciara what is syphilis?

Ciara Shank Certified Nurse Midwife (Guest): Syphilis is a bacterial STD that is spread through skin to skin contact during some form of intercourse.

Host: And then how does syphilis differ from other STIs? So we kind of have a comparison.

Ciara: So what differs from syphilis is, with gonorrhea and chlamydia, it's spread through fluid and also open areas in the vagina, mouth, rectum. Whereas syphilis is spread through sores in the vagina, rectum and mouth. And then at one point was those numbers dropped lower and now we're starting to see a rise.

Host: So that's interesting. Why do you think we're seeing a rise in syphilis cases?

Ciara: What we've been trending is that it's based on the area. Certain areas, low socioeconomic areas tend to have higher risks of having syphilis. We cannot pinpoint why exactly those areas are being hit the hardest.

Host: So I think you mentioned earlier, syphilis is a bacterial infection, so that means it can be treated. Is that right? Tell us about that.

Ciara: The good part about it being a bacterial infection is that we can treat it. And it depends on the stage. So there's four typical stages of syphilis that you will see different symptoms. The first stage is what we call the primary stage. Most people will have sores. These sores are small. They're not painful. They are very shallow and we call those chancres. And so you again, have them on your mouth, on your genital area and that's the first stage of syphilis. The second stage, we typically see rashes, so not the sores, but typically rashes on the body, palms of the hand or the soles of the feet, some people may get them in their mouth. Some people may have a rash on their stomach. But typically there's no other symptoms involved in that.

After that we will go into a different phase. It's called a latent phase where you won't see any symptoms at all. And then the last phase of syphillis is called the tertiary phase. And in that phase most people develop other symptoms in their body. So it will be like neurological deficits so what would be considered dementia, aggitation, seizures, things like that.

Host: That's really interesting. So, if left untreated, it can cause these types of more severe or serious symptoms.

Ciara: Correct. It can.

Host: So when you talk about dementia and some of the more severe things, if I found out that you have syphilis, can you reverse that then? Can you treat it and reverse the dementia? How does that work?

Ciara: So, in the first, second and third phase of syphilis, those are the areas that is easily treatable and reversible. And that last stage,tertiary syphilis, that is the stage that once the damage has set in, or started, you can't reverse it. However, you can still give treatment. However, it won't reverse the effects that it has on the rest of your body.

Host: You mentioned when it's in the latent stage, there are no signs or symptoms. So how is this generally diagnosed? How would somebody even know if they have syphilis?

Ciara: If a patient comes in and they want to have STD treatment, we test for syphilis by the blood. We do one particular test. And then we follow up with a confirmation test if that first test is what we consider reactive or positive. We typically have patients come in and get tested if they are between the ages of 16 and sexually active and younger than 30. And we want them to be tested every year with that bloodwork.

Host: So I'm just curious, do people find out that they have syphilis through going to the doctor for a regular physical exam and having their blood drawn, and then you get the results back and oh my God, there it is I have syphilis. Do people find out that way unknowingly when they go to the doctor, it's discovered?

Ciara: So we recommend at each annual that we, that our patients do get tested for all STDs, that includes syphilis. And again, what we will see with the lab work is that we'll get a positive test. It typically takes around five to seven days for the results to come back. We'll see that initial, if it is positive, a reactive test. And then we repeat it again, we repeat for a confirmation test.

Host: Wow. This is really interesting and eye-opening, I'm sure for a lot of people. So, then the next question is how can someone reduce their risk of getting syphilis?

Ciara: So, with syphilis just like any other STD, the big part is if you are sexually active, whether it's oral sex or penetration. It is important to know your status and it's important to know your partner's status. So making sure that you are getting tested for all STDs is definitely important. The way to protect yourself completely is with condom use. And of course, abstinence is what we know to be the most effective prevention of syphilis.

Host: So then who is at risk for syphilis, any sexually active person?

Ciara: We see certain populations, so again, certain areas are more syphilis is more prevalent. Those who are risk factors for having syphilis is anybody who is involved in, who has a lot of sexual partners, those who are in a younger population are at higher risk of having syphilis or any other STD, if somebody is not using protection, they are at higher risk of havng syphilis.

Host: So then that brings up the question what about pregnant women? Do they get treated for syphilis at their first prenatal visit?

Ciara: The CDC has recommended that we test every pregnant woman at the beginning of her pregnancy. We repeat that test again in the middle of the pregnancy, around 28 weeks and then some hospitals and some groups we do repeat the test when they are admitted to the hospital and the reason for us to keep repeating it is because it can lead into what we call congenital syphilis that can be transmitted to the baby.

Host: Okay. So can you talk more about that? If a woman is pregnant and has syphilis, you said it can be transmitted to the baby. What happens in that case? How does it affect the baby?

Ciara: Once we detect syphilis in the mom, what we do is we make sure we treat with an antibiotic called penicillin. If it is not treated and it's passed to the baby, we can see those neurological issues with the baby. The baby could be really small. The baby could come prematurely. The baby can have seizures. And the baby can have issues with their eyesight and with their hearing.

Host: Since this is so potentially serious, should everyone get tested for this? Does that make sense?

Ciara: Absolutely. Everybody should know their status with all STD's with gonorrhea, chlamydia, trichomonas also HIV, hepatitis and definitely syphilis. That is the most key thing of prevention is knowing your status.

Host: And then, especially if you see something, if you're having outward symptoms, you definitely should go see your doctor, right?

Ciara:

Know that that sore there, because it's not painful. But if you do notice it, it's definitely important to come and see your primary care doctor, your obstetrician, whomever it is that you get your care through.

Host: So then if left untreated, does it stay with you your whole life? It's basically active inside your body, even though it might be in the latency stage where there's no outward symptoms. It's still inside you it's still living is that right?

Ciara: As long as it's treated it won't stay with you going back to those two tests that we talked about the first test if you're positive at any point,even if you receive treatment, if you're positive, that test will still come back as what we

Host: So, then say that you contracted it and you did find it and have it treated and you cured it with antibiotics. You caught it in one of the first three stages where it can be treated and cured, can you get it again then do you have to continue to worry about this?

Ciara: What we make sure that we try to do is educate patients on safe sex. So if you've been treated

Host: And what is the, just so people know what is the most recognizable symptom of this? Just so people know what to look for. We've talked about outward signs and sores. What does a syphilis soar look like?

Ciara: it has a little shallow circle in that middle of the circle, it's a shallow area. Again, it's not painful, what makes it easier to miss. Really hard to see that sore if something is not painful. Typically, we see people come in during that secondary phase when they notice rashes on their hands and on the soles of their feet, on their stomach that they never saw before.

Host: So does it always progress like that? If you have it, will it always go to sore, rash, other symptoms then latency. Does it always progressed like that? Or will it go sore and then just disappear?

Ciara: Nope. you typically will have those same symptoms. It's just whether or not you will recognize those symptoms.

Host: Okay. Well, that's good to know then that it does worsen before it goes into the latency phase. So if you have the sore, then the rash and it can also cause fever and things like that as well, too. Right. Because it is an infection.

Ciara: It is. the hardest part with having a fever and swollen lymph nodes is

that could be anything.

Host: Got it. All right. So then what do we do now Ciara? If someone thinks they have syphilis, what's the next step?

Ciara: The next step will be to come in and see your provider. That's the biggest thing that you can do. Always use protection with your partner. But when you think you have syphilis, definitely come on in or any STD in general, any questions or concerns. It's definitely better to come in. So that way we can do an examination and also have you get those labs tested.

The other part of that is making sure that if you have sores or symptoms, don't engage in any intercourse whether it's oral sex or vaginal or anal intercourse. Avoid sexual contact at that time until you and your partner have both been tested.

Host: Right. It seems like the minute sore appears, or you will find one, if it's visible, it seems like you should go to the doctor right away. Is that right?

Ciara: Absolutely.

Host: Yeah, this has really been eye opening Ciara. You know, a lot of people have heard about syphilis or STIs, but maybe not the ramifications of what it can do to you if gone unnoticed and untreated. Well, thank you so much for your time. Is there anything else you want to add or say to anyone listening right now, as we wrap up our discussion about syphilis?

Ciara: Yeah, so even though this conversation was specifically geared toward syphilis, I can't stress enough that if you do contract syphilis, you are also at a higher risk of contracting other STDs. So, always, always, always use safe sex. Visit your doctor on a routine basis and just know your status. Know your partner's status.

Host: Absolutely. Make sure you are getting tested, know your partner's status, use protection the right way. And if you suspect something is wrong, you see something or you're getting the secondary rash, the infection, make sure you see your physician. You don't want to just blow it off that's for sure. Ciara, thank you so much for your time. This has really been informative. We appreciate it. Thank you again.

Ciara: Thank you.

Host: And once again, that's Ciara Shank. And for more information, visit upmc.com/centralpaobgyn. Once again, upmc.com/centralpaobgyn. And if you found this podcast helpful, please share it on your social channels. It could make a difference in someone's life. And check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.