Resurgence of Syphilis Among Men Who Have Sex With Men

Syphilis is a sexually-transmitted infection that, if untreated, can have severe health consequences. In addition, the sores caused by syphilis can promote the spread of HIV infection among sex partners. This issue of CHART focuses on the resurgence of syphilis in Philadelphia.


Syphilis Case Counts Have Been Rising in Philadelphia Since 2005

Source: Philadelphia Department of Public Health, Division of Disease Control
  • Infectious syphilis includes cases diagnosed with primary, secondary, or early latent (evidence of acquisition within last 1 year) stage of disease.
  • Syphilis diagnoses have been steadily increasing since 2005, with a sharp rise noted in 2016.
  • Between 2005 and 2016, infectious syphilis diagnoses more than quadrupled, from 208 to 925.

Syphilis Disproportionately Affects Men Who Have Sex With Men

Source: Philadelphia Department of Public Health, Division of Disease Control
  • In 2016, 61% of all reported infectious syphilis cases were among men who have sex with men (MSM).
  • Cases of infectious syphilis are also increasing, but more slowly, in women and men who have sex with women.

Most Persons with Syphilis Have HIV Infection

Source: Philadelphia Department of Public Health, Division of Disease Control
  • The majority (59%) of infectious syphilis cases among men were co-infected with HIV.
  • 52% (296/567) of infectious syphilis cases among men were under 30 years of age.
  • Syphilis rates were approximately twice as high in African-Americans as whites.

MSM with Syphilis Claim 5 to 9 Sex Partners

Source: Philadelphia Department of Public Health, Division of Disease Control
  • Among MSM with infectious syphilis, the mean number of sexual partners claimed during the 12 months prior to diagnosis has varied from 5 to 9, but has not changed significantly since 2014.
  • The mean number of sexual partners claimed by women and men who have sex with women has been increasing in recent years, and was not significantly different from MSM in 2016.

MSM with Syphilis Frequently Met Their Sex Partners Through Mobile Apps

Source: Philadelphia Department of Public Health, Division of Disease Control
  • Mobile apps use geo-positioning to locate potential sex partners. These apps present a challenge for identifying and treating sexual partners of syphilis cases because the interaction is often anonymous and cannot be re-traced.

What Can Be Done

The Health Department is:

  • using various strategies to reach people at risk of syphilis, including through social media, mobile technology, and dating apps.
  • advising the public about the importance of syphilis testing and prevention.

Health care providers can:

  • regularly and routinely test high risk individuals, especially sexually active MSM, for syphilis.
  • increase suspicion of syphilis in patients who present with rashes or sores, especially among men who have sex with men.
  • treat presumptively for syphilis when genital ulcers or plantar/palmar rashes are present, suggesting early infection.

People can:

  • know the signs and symptoms of syphilis, which include painless genital ulcers or a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. Seek medical care if you suspect you have been exposed or infected with syphilis.
  • seek regular testing for syphilis if you are at high risk, especially if you change sex partners.
  • use condoms every time to prevent infection with syphilis. Limit your number of sexual partners and know who they are.

Suggested citation: Philadelphia Department of Public Health. Resurgence of Syphilis Among Men Who Have Sex With Men. CHART 2017;2(6):1–3.

CHART is a publication of the Philadelphia Department of Public Health, and is intended to highlight under-reported or under-appreciated public health issues in an effort to kick-start a conversation. Readers can subscribe to CHART on Medium, or on our website.

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