PathAdvantage | 04/08/2025Syphilis. Speaking as a pathologist, it is time we looked at this disease through the lens of modern medicine with a clear-eyed view. There is a dangerous misconception that syphilis is a relic of the past, an obsolete condition — a disease of top hats, corsets, Victorian prostitutes, and pirates. But that’s not true.
Syphilis is back. And in some places, like Texas, it’s back with a vengeance. Which makes this April’s STI Awareness Month particularly important.
The resurgence of syphilis, particularly the congenital form — passed from mother to baby — represents a public health crisis. Texas is seeing numbers not seen in decades, a reminder that complacency in medicine is dangerous. Again: This isn’t just a problem in some far-flung corner of the world. This is happening in Texas, today.
Syphilis And Stigma
There’s a certain stigma attached to sexually transmitted infections, which can cloud judgment, lead to assumptions, and get in the way of proper care. Even impartial doctors might fall into this trap. We may see a patient, make a snap judgement — “monogamous, unlikely to have syphilis” — and suddenly, the diagnostic process is skewed. This is precisely the sort of thinking that allows syphilis to thrive. We need to dispel these myths. Syphilis doesn’t discriminate based on appearances or assumptions. It affects everyone.
Unfortunately, younger doctors, having trained when syphilis rates were lower, may not be as familiar with the disease’s varied presentations and the complexities of diagnosis. This is understandable; testing for syphilis has a “traditional” algorithm, a “reverse” algorithm, with multiple acceptable versions of confirmatory testing. We need to bolster education and ensure that all physicians, regardless of experience, are equipped to recognize and treat syphilis. This includes understanding the nuances of testing, the importance of partner notification, and the long-term consequences of untreated infection.
Congenital Syphilis Skyrocketing
The situation in Texas is particularly concerning. Congenital syphilis rates are skyrocketing, far outpacing the national average. In 2022, 922 cases of congenital syphilis were in Texas, representing approximately 25% of all congenital syphilis cases in the USA (3,755 cases of congenital syphilis were seen in the USA in 2022.) That’s two to three babies born with congenital syphilis every single day in Texas. These aren’t just numbers, these are lives – lives potentially devastated by a preventable disease.
What can be done? Increased testing and better access to treatment, without question. But perhaps most importantly, a change in mindset. We need to break down the stigma surrounding STIs. We need to educate both doctors and the public. We need to understand that syphilis can affect anyone, regardless of their background or perceived risk. We need to treat every patient with the same level of care and attention, regardless of our own biases.
References:
Jessica Ridge, Enhancing Awareness: Physicians Can Help Dispel Myths to Ease the Syphilis Epidemic. Texas Medicine, January 2025.
National Overview of STIs in 2023: www.cdc.gov
Congenital Syphilis in Texas in 2022: Dept of State Health Services.