What About the Other Diseases: Syphilis

Often, the public discourse on HIV/AIDS continues to be so strong (and rightly so) that it can overshadow some of the other tremendous global health problems in our world. Syphilis continues to be one of these ’silent’ problems that are relatively small to those in richer nations, but still continue to have huge, detrimental effects on the developing world. The Journal of the American Medical Association recently published an article talking about the prevalence of syphilis stating that while the U.S. has seen dramatic overall improvements over the last 50 years, much of the world still suffers from the burden of syphilis:

…congenital syphilis remains a major problem in developing countries, and globally is estimated that 0.7 million to 1.5 million cases occur annually, the majority resulting in stillbirth or perinatal death, due to lack of screening and treatment.

The WHO also states that the need to eliminate syphilis remains one of the key areas for action in global health:

Every year, at least half a million infants are born with congenital syphilis. In addition, maternal syphilis causes another half million stillbirths and miscarriages annually. Yet, with the development of reliable and simple tests the disease could be easily screened and treated at little cost by giving infected women a single dose of penicillin early in pregnancy.

According to the JAMA article, in 1944, the prevalence in the United States was estimated from 5% to 10%, with up to 25% in “lower socioeconomic groups.” With the advent of penicillin and a major control and treatment effort, syphilis in the U.S. dramatically decreased:

From 1944 to 1954, rates of reported cases of syphilis of any stage decreased by more than 75% … by 1975, rates of overall syphilis had declined by almost 90% …even more dramatic was the reduction in mortality due to syphilis, which declined by more than 98% from approximately 14/100 000 in 1940 to less than 0.2/100 000 by 1975.

All this is to say that while control and treatment of individual diseases has proven effective in lowering prevalance rates in rich countries, as in the case of syphilis, often this has been because of an existing health infrastructure that allows for such an effective and coordinated approach. If we’re going to tackle diseases like syphilis and HIV not just in isolation, but simultaneiously, then we are going to have to support poorer nations in having stronger health care; health care that can not only provide penicillin for Syphilis, but provide ARVs for HIV, and short-course treatment for TB.  It’s easy to take the route of  being “only focused on AIDS”‘ or “only focused on syphilis”…it’s much harder to make the bridge to be “focused on health inequities,” but that is what is demanded of all of us in global health if we are going to have the ability to succesfully tackle these problems.