Syphilis, STIs growing threat to U.S. Armed Forces - United States Army

Reported rates of syphilis among active-duty service members have increased by 40 percent from 2020 to 2022 and doubled from 2014 levels. Defense public health experts say this is an individual and public health issue that also impacts mission readiness. (Defense Centers for Public Health-Aberdeen graphic illustration by Jessica Saval) (Photo Credit: Jessica Saval) VIEW ORIGINAL

ABERDEEN PROVING GROUND, Md. – Syphilis, gonorrhea, and chlamydia are continuing to spread in the United States – affecting millions of men and women of all racial and ethnic groups. The Centers for Disease Control and Prevention describes the continuing rise of these sexually transmitted infections, or STIs, as an epidemic that is not slowing down.

STIs have also been increasing in U.S. active-duty populations. The March 2023 Department of Defense Medical Surveillance Monthly Report, or MSMR, shows STIs steadily increasing among U.S. active-duty service members between 2014 and 2022.

As previously reported by the Defense Centers for Public Health–Aberdeen, service members are considered a high-risk subgroup of the overall U.S. population because they largely fall within the highest risk age group of 15–24 years old. Service members also report behaviors that may increase STI risk, such as binge drinking, and may also have unique risks due to increased travel and mission-related stressors.

Syphilis example

Based on its most recent surveillance report, from 2021 data, the CDC reported an all-time high of syphilis, with an increase of more than 30 percent in one year.

The MSMR indicated a slight dip in military STI rates in 2019 for all STIs except syphilis; its rate has continued to rise. Syphilis rates have consistently been highest among non-Hispanic Black service members, especially women under 25 and men under 34.

"Among military service members, there was a 40 percent rise in reported syphilis from 2020 to 2022," says Magdalena Danaila, a registered public health nurse at the Defense Centers for Public Health – Aberdeen. "The military's syphilis rate is now double that of 2014. This is an alarming increase."

"Syphilis has been around for centuries – and was historically a known problem among Soldiers and Sailors," says Danaila. "Though penicillin was discovered to be an effective treatment for syphilis almost a hundred years ago, syphilis itself never went away."

Danaila provided answers to some commonly asked questions about syphilis to increase awareness among service members and encourage testing and treatment.

What is syphilis?

Syphilis is a bacterial infection transmitted from contact with a syphilis sore during vaginal, anal or oral sex. Symptoms can look like those of many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months or even years.

There are four stages of syphilis infection. The first, or primary, stage is a painless sore or ulcer that usually appears at the initial infection site between 10 days to 3 months after sex with someone who has syphilis. The sore, which may be faint and hard to notice, may last up to 6 weeks and go away, even without treatment. This does not mean you no longer have syphilis.

Without treatment, syphilis bacteria spread through your blood. During this secondary stage, there may be a skin rash such as on the palms of your hands or bottoms of your feet. Effects to the brain and nervous system, the eyes, or the ears may occur, such as headache, fever, swollen glands, or vision and hearing problems.

If still untreated, syphilis will move to a latent stage in adults. This stage, which is a period when there are no visible signs or symptoms, can last for years. A blood test can still identify the infection.

Some people with untreated syphilis can develop the most severe form of the disease 10 to 30 years after the infection began. At this point, damage to the heart and blood vessels or the brain and nervous system can result in permanent mental illness, paralysis or death.

How do you get syphilis?

You can get syphilis if part of your body touches the skin ulcer or rash of someone with syphilis. This happens most often during sex. A pregnant person with syphilis can also pass the infection to their unborn child. This type of the disease is called congenital syphilis.

How do I know if I have syphilis?

Most of the time, healthcare providers will use a blood test to test for syphilis. Some will diagnose syphilis by testing fluid from a syphilis sore. Only laboratory tests can confirm whether you have syphilis.

Some STI testing may be included as part of wellness visits for young military women, but male service members who don't have symptoms are less likely to get tested, and they might infect others. The only STI required for testing among all military active-duty is HIV, so if you are sexually active, talk to your healthcare provider about testing for syphilis.

All pregnant people should receive syphilis testing at their first prenatal visit and may need follow-up testing.

Others at higher risk for syphilis are persons who have had a partner who tested positive for syphilis; gay or bisexual men; and individuals with HIV or who are taking pre-exposure prophylaxis (PrEP) for HIV prevention.

 I'm pregnant. How does syphilis affect my baby?

 If you are pregnant and have syphilis, you can give the infection to your unborn baby. Having syphilis can lead to a low-birth-weight-baby. Babies infected with syphilis can have health problems, such as cataracts, deafness, or seizures, and can die. To protect your baby, you should receive syphilis testing at least once during your pregnancy. Receive treatment right away if you test positive.

Is there a cure for syphilis?

Yes, syphilis is curable with the right antibiotics from your healthcare provider. Penicillin, a common inexpensive antibiotic, remains the preferred treatment. However, treatment might not undo any damage the infection has caused.

Penicillin may not be suitable for everyone, and it is in short supply in the U.S. Your healthcare provider can help determine the best treatment for you. Follow-up testing by your healthcare provider is necessary to make sure your treatment was successful.

Can I get syphilis again, after receiving treatment?

Yes. Having syphilis once does not protect you from getting it again. You do not develop immunity. Even after successful treatment, you can get syphilis again.

How do I prevent syphilis?

It may not be obvious that a sex partner has syphilis. Syphilis sores in the vagina, anus, mouth, or under the foreskin of the penis can be difficult to see.

The best defenses against syphilis are the consistent use of condoms during sexual activity, along with regular testing, especially for individuals with multiple or new partners.

If you are diagnosed with syphilis, inform your current and past partners immediately so they can get tested and, if needed, treated for the disease.

Where can I get more information?

Service members can combat syphilis through awareness and open discussion with partners and healthcare providers, preventive actions, testing and swift treatment.

For more information on syphilis, review this CDC Factsheet, visit the Defense Centers for Public Health – Aberdeen Sexual Health website, or talk to your healthcare provider.

"Syphilis isn't just a health issue," says Danaila, "It's a mission readiness issue. Leaders should share awareness without stigmatizing this disease, and encourage prevention, testing, and treatment."

The Defense Health Agency supports our Nation by improving health and building readiness—making extraordinary experiences ordinary and exceptional outcomes routine.

NOTE: The mention of any non-federal entity and/or its products is for informational purposes only, and not to be construed or interpreted, in any manner, as federal endorsement of that non-federal entity or its products.

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