Syphilis Resurfaces in Wake of Drug Epidemic

By Dorri Olds 10/05/17

“We need to become more comfortable speaking about sex and drugs.”

blood test for syphillis held by blue glove
Syphilis is on the rise again in part due to the opioid epidemic.

HIV/AIDS is not the only STD Americans ought to worry about. Syphilis, once dismissed as a relic, is back and it’s spreading at alarming rates. Among the hardest hit are communities with high rates of heroin and methamphetamine addiction.

Donnica Smalls, MA, of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), a sub-division of the Center of Disease Control and Prevention (CDC), updated The Fix about this frightening societal scourge: “In 2015, a total of 23,872 cases of primary and secondary (P&S) syphilis were reported in the United States…. This rate represents a 19% increase compared with 2014.”

Antonio Urbina, MD, an associate professor of infectious disease at Manhattan’s Mount Sinai Hospital, told The Fix about the increase in patients who have contracted syphilis. Most of them are drug users.

“When someone is in the throes of addiction,” said Dr. Urbina, “their judgment is impaired. The addiction is so overwhelming that they’re inclined to have condomless sex and they’re sharing needles. Many are having sex in exchange for drugs with other members of high-risk groups, like the formerly-incarcerated, or men that are gay or bisexual.”

Smalls again referred to the CDC’s findings: “In 2015 the rate of reported P&S syphilis cases among men (13.7 cases per 100,000 males) was much higher than the rate among women (1.4 cases per 100,000 females), and men accounted for a large majority (90.3%) of P&S syphilis cases. Men who have sex with men (MSM) accounted for the majority of new P&S syphilis cases (82% of male cases with known gender of sex partner). In terms of race: rates of primary and secondary syphilis are highest among African-Americans.”

Urbina said that it is not clear yet why African-American and Hispanic men are more susceptible. He agreed with my theories that it is likely due to institutionalized racism; people of color have less access to resources such as health insurance which would cover STD testing. For the same reason, marginalized communities lack sufficient education about safe sex practices, and there is a shortage of treatment drugs.

One of the biggest concerns in America now is the Republican-proposed funding cuts to Planned Parenthood and attempts to destroy the Affordable Care Act. Impoverished neighborhoods will be hit the hardest.

Urbina said, “We also know that poverty and racism tend to drive people into secretive behaviors. When they’re not open about their sexual orientation that can lead to higher-risk behavior, including not seeking primary care. There may also be more stigma about being ‘out’ especially with transgender individuals in the Hispanic and African-American communities. There is a lot of stigma and family pressure so [LGBTQs] often hide their true identity. We know that causes internal anxiety, depression, and all those things feed into higher-risk behaviors.”

Another high-risk group lies within the depraved world of sex trafficking. I reached out to Jerome Elam, the president and CEO of Trafficking in America Task Force, a nonprofit organization that is tirelessly fighting the brutal world of sex slavery. Elam is a Marine veteran and a survivor—his childhood was stolen by human traffickers.

“Syphilis is increasingly becoming a problem because of the opiate epidemic and that’s a phenomenon that affects human trafficking,” Elam told The Fix. “Drugs have always been a tool among human traffickers. Addiction is used to manipulate victims. Traffickers either entice a young boy or girl with romancing, or they simply kidnap them. Then they get the kids addicted to a drug like heroin and use it for control. Withholding the drug becomes a method of discipline. [When] someone goes into withdrawal, they’re willing to do anything to get the drug.

“Opiates are used as currency. Kids are bought and sold, either with drugs or money. The opportunity to molest a child is traded for drugs. As a survivor, and having been a victim, I know you’re given drugs to make you more compliant. What happens is that your addiction is not just about the physiological effects. The craving is because it numbs you to what’s going on. And even after victims escape or are rescued, they’ll still gravitate towards drugs because it is so difficult to deal with that trauma you went through on a daily basis. Drugs are a way of self-medicating.”

I asked Elam how the kids were infected with syphilis. He said, “There’s no bottom to the depravity in human trafficking. Dirty needles are shared. Victims are objects. Nobody cares about them. According to the FBI, the average life expectancy [for a victim] is seven years. Human trafficking is a big driver of the AIDS epidemic and now it is spreading syphilis, along with other sexually-transmitted diseases. I was sold to a high-powered clientele so condom use was mandatory but at the lower levels condomless sex is pervasive.“

There is another disturbing trend in recent years—an increase in syphilis among women which has triggered a surge in congenital syphilis (passed from mother to child).

The CDC’s Smalls said, “In 2015, there were 487 reported cases of congenital syphilis—the highest since 2001. Congenital syphilis can result in miscarriage, stillbirth, and severe health complications for an infant. The disease is preventable through routine screening and timely treatment for syphilis among pregnant women. However, women still account for less than 10% of new P&S syphilis infections.”

Click here to learn more about congenital syphilis. The CDC advises all pregnant women get tested for syphilis.

“We need to become more comfortable speaking about sex and drugs,” said Dr. Urbina. “To ask open-ended, non-judgmental questions that normalize sex. As a provider, we need to ask, ‘Do you have sex? Do you find it difficult to always use condoms? How many partners do you have?’”

Urbina emphasized the importance of being direct and specific. “I had a man that I saw as a patient, just for a routine annual exam. I specifically go through the questions. When I asked him, ‘How do you identify?’ He said he’s a heterosexual male. Then, I asked, ‘Who are your sexual partners?’ He goes, ‘Women.’ I specifically asked, ‘Do you ever have sex with trans women?’ You know, male to female. And he said, ‘Yes.’ But we need to get a little more granular so I asked, ‘What types of sexual activity do you engage in? Is [your penis] inserted vaginally?’ He goes, ‘Yes.’ Then, I was like, ‘Do you ever engage in any anal receptive sex?’ He said, ‘Yes.’...The reason that’s important is because otherwise I would not have known to do an anal test.

“We need that type of care to be built into general primary care. I think providers often feel embarrassed about asking those questions. Or, they feel like they’re going to come across as judgmental. You know, it’s actually the opposite because I think patients appreciate you asking, and they want to tell. In that same regard, if somebody does screen positive for syphilis, I say, ‘Hey, this is what you have. We’re going to give you treatment. It’s important that you wait a certain period of time after your treatment before you resume any sexual activity so you don’t infect your loved ones or partners or any others.’ Then I ask them to identify their sexual partners and say, “We need them to come in for a screening so we can offer them treatment as well.”




Many people who are infected are completely unaware they have syphilis. The disease is spread via anal, vaginal and oral sex. It has been nicknamed “The Great Pretender” because the symptoms look like other diseases and are often misdiagnosed. In many cases, there are no symptoms at all. If caught early, it’s easy to treat with penicillin. There are three stages: primary, secondary and late.

In the primary stage (between 3 weeks and 3 months) a chancre sore can appear at the spot where the disease entered your body. The sores are usually round, firm and painless, and unlike oral herpes, they rarely appear on your mouth. They can pop up in areas that are not visible and because they’re not painful, you and your sexual partner(s) may not even know they exist. These sores are extremely contagious. They usually last anywhere from 3 to 6 weeks then disappear.

During the secondary stage, rashes can appear on the palms, soles of feet, or other body parts. The rash does not itch and can even be difficult to see. During this phase, it’s easy to mistake symptoms for a cold or mild flu. You may experience headaches, muscle aches, tiredness, swollen glands, sore throat, and/or a low-grade fever. You may also lose weight and notice hair loss. The rash can last 2 to 6 weeks but can come and go for up to 2 years. But without treatment the symptoms will go away on their own.

Between this secondary stage and the late stage, you may have no symptoms for months or even years. However, untreated late stage syphilis can cost you your eyesight, cause tumors, paralysis, damage to your nervous system and organs. It can even kill you.

The good news is that syphilis is easily curable with antibiotics. The bad news is that if it is not caught during the first phase, treatment will cure the infection and stop it from progressing any further but the damage already caused cannot be reversed. If you have had multiple partners, and unprotected sex, get thee to a medical clinic post-haste for a blood test.

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Dorri Olds is an award-winning writer whose work has appeared in many publications including The New York Times, Marie Claire, Woman’s Day and several book anthologies. Find Dorri on Twitter, Facebook, and LinkedIn.