As the old saying goes, “Laughter is the best medicine. Unless you have syphilis in which case penicillin is the best choice”. The disease, caused by the bacterium Treponema Pallidum and passed on through unprotected oral, vaginal and anal sex, has affected the famous through the ages (Al Capone and, reportedly, Hitler, to name just two). But syphilis is in no way confined to big names, nor is it a sexually transmitted infection (STI) of the past. The 2016 Public Health England (PHE) syphilis report has shown that infection rates are on the up, with disproportionate rates in London. In 2015, the capital accounted for 56% of all cases in England, with a 22% increase in diagnoses in the year 2014-15. Since 2010 the number of cases of syphilis in Londoners has increased by 163%, with a 22% increase in the year from 2014 to 2015. The borough of Lambeth has the highest rates, closely followed by the City of London and Southwark. Men who have sex with men (MSM) represented 90% of all syphilis cases in 2015, with a 232% increase in diagnosis over the last five years, said the report. More than half of the MSM diagnosed with syphilis in 2015 were also infected with HIV, and over half additionally tested positive for a separate STI. Rates in heterosexuals remain stable but are higher than ideal.
It’s 2016. Safe sex campaigns and targeted prevention efforts are in place. Sexual health care is free and accessible to both high and low risk groups. So what is going on? The basic science can’t be sugar coated. More condomless sex leads to higher rates of syphilis, (and gonorrhoea, chlamydia, HIV … the list goes on). Untreated syphilis means the disease continues to be passed on and leads to potentially horrifying long-term medical complications. Action is needed now to address the reasons behind these patterns, particularly in MSM, the group most affected. In MSM, higher numbers of partners is a key reason behind the heavily inflated rates, compounded by the use of apps such as Grindr, venue based and group sex. The reported increased use of Chemsex (recreational drugs used during sex) is also of concern, lowering sexual inhibitions and making the likelihood of using a condom less likely. Another worrying phenomenon is “sero-sorting” – when men choose partners who have the same HIV status, in theory negating the need to use a condom. However, this puts both partners at high risk of contracting a plethora of STIs. So what to do? A wag of the finger and a warning to wear condoms is insufficient. While individuals do need to take responsibility for their personal health, adequate support and infrastructure is essential to achieve better sexual health in the UK and turn around these rising figures. Progress begins with knowledge, which in turn begins with education. Sex education in schools remains an optional curriculum, with countless young people, particularly teen MSMs, missing out on vital advice needed to keep them healthy.
Sexual health clinics manage the majority of syphilis testing and treatment and so attention must be paid to the massive budget cuts being faced by sexual health and MSM support services. MSM are advised to have regular STI checks (which includes a syphilis test), use condoms and seek support if they are struggling to maintain their personal health. Only robust, accessible and adequately funded services will be able to maintain this level of care. Responsibility is now on the government to ensure the needs of some of its most vulnerable populations are being met. Further study is needed to look at the complex background to increasing rates of STIs in high risk groups. But while syphilis has been a feature of centuries past, there’s no doubt that its story now should be confined to the history books.