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Why is syphilis making a comeback in London?

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Syphilis is often thought of as an historic sexually transmitted infection.  It was prevalent up until the mid-20th century after which numbers of infections dropped significantly through effective antibiotic treatment and an awareness of signs and symptoms.

But worryingly, syphilis has returned as a threat to our population.

We’ve published a report looking at rates of syphilis in London. We have been seeing cases of this infection rise in London year-on-year and we now have rates of syphilis three times higher than anywhere else in England.

In 2015 there were nearly 3,000 cases of syphilis diagnosed in London residents and when we look at rates of the infection across England, London alone accounts for 56% of all diagnoses.

Whilst we’ve seen increases in many STIs in recent years, syphilis is fast emerging as a serious public health concern in the capital.

We know that London has the highest burden of new STI diagnoses in Englandand attaining good sexual health is one of the biggest public health challenges facing people in the city today.

But figures showing syphilis alone has increased by 163% since 2010 are alarming. It has been diagnosed in all 33 London local authorities and in 2015 most saw an increase in cases.  This means that many people at risk from the disease may in fact not be aware of this threat to their health.

Cases of syphilis have been reported among both heterosexuals and men who have sex with men (MSM) in London, however MSM are disproportionately affected.

Despite representing around 2% of the London population, in 2015 MSM made up 90% of all cases and there was an 18% increase in cases of syphilis among MSM in just one year (2014 to 2015).

Although cases in heterosexuals in the capital are more stable, they too continue to be high compared with elsewhere in England given the effective preventative measures which are in place.

So we are taking this opportunity to raise awareness about the risk of syphilis and its signs and symptoms and our key message is that this is an entirely preventable infection (like all STIs), if you practice safe sex.

Syphilis is transmitted through sexual activity, including oral sex, with an infected partner though of course that person may not know they are infected.

This risk is real, given that some people can be infected and not show any symptoms for years.

If partners practice safe sex – crucially this includes using condoms, regularly being tested and avoiding overlapping sexual relationships – they will greatly reduce their risk.

If it is contracted, most cases are treatable with antibiotics; but it can be very serious if left undiagnosed.

This risk is real, given that some people can be infected and not show any symptoms for years. In addition the early symptoms of syphilis can easily be mistaken as signs of other more general health conditions.

Many people associate STIs with specific symptoms such as discharge or burning sensations, but syphilis does not present with any of these.

There are several stages of syphilis infection; primary, secondary and latent and late stages, the latter being the most serious.

Primary syphilis infection will often present about three to four weeks after someone has been infected with the bacteria and individuals may develop a painless ulcer or rash (lasting for three to six weeks) on the genitals, rectum or inside the mouth.

It is not always easy to detect this initial symptom and we know people can often fail to notice at all.  Secondary syphilis will then follow, this is characterised by general symptoms such as a fever, headaches and night sweats among others; if left untreated it can then progress into latent and further late stage syphilis.

At this stage the STI is characterised by more serious health complications that can include cardiovascular problems, central nervous disease and paralysis; damage caused to the body from late stage syphilis can be fatal.

In London we have excellent open access sexual health services which provide free STI testing and treatment, notification for the sexual partners of those diagnosed with an STI and free provision of contraception.

These services are available across the capital and there are also regular sexual health awareness campaigns (for example promoting condom use) to raise awareness of the importance of practicing safe sex.

It is important for people in London to know their local services; both NHS Choices or MyHealthLondon will help people identify where to go for help.

Many people may think that STIs generally are not serious. In most cases they are treatable, however some sexually transmitted infections are difficult to treat because they are now becoming resistant to antibiotics, and some like syphilis can cause long term health effects.

Chlamydia and drug resistant gonorrhoea can also cause troublesome long term effects.

We hope that today’s report will further raise awareness of sexually transmitted infections, in particular syphilis and the importance of practising safe sex.

I urge anyone who thinks they may have syphilis, or who may have been at risk of contracting an STI to get a sexual health test as soon as possible.

Improving the sexual health of Londoners is a priority for me and my team at PHE London.  We continue to work with colleagues and organisations across the system to reduce the burden of poor sexual health in the Capital.

This blog was originally published on

Author – Professor Yvonne Doyle.
Regional Director for London at Public Health England

17th August 2016.