Syphilis: Argentina warns of a 40% increase in this sexually transmitted disease

Sexually transmitted infection (STI) syphilis continues to grow in Argentina

One of the most contagious sexually transmitted infections (STIs) in existence is syphilis, which is experiencing a worrying growth in Argentina. And the data provided by the Ministry of Health of the Nation confirm the increase, mainly among young people aged 15 to 34.

According to the latest National Epidemiological Bulletin (BEN) prepared by the health portfolio, during the period 2018-2023, a total of 129,620 cases of syphilis in the general population were reported to the national surveillance system in Argentina.

Cases and rates showed an upward curve between 2018 and 2019 and a decline in 2020 and 2021 due to the coronavirus pandemic. But in 2023, record numbers were recorded, with 32,293 cases, at a rate of 88 per day, which means the highest number of infections in the last three decades.

Evolution of syphilis rates in the general population by region in both sexes in Argentina – Period 2018 – 2023 (Ministry of Health)

The data for 2023 represent a 42% increase compared to the cases recorded in 2018, when 22,734 infections were reported.

And in 2024 the trend will continue in a similar way, with 19,919 cases compared to 20,183 recorded in the same period last year. Although this is a slight decrease, the numbers are still high compared to previous years.

Tissue sample showing the presence of Treponema pallidum spirochetes, the bacteria responsible for syphilis. (Skip Van Orden/CDC via AP, File)

“Syphilis is considered a significant public health problem, with effective measures for its prevention, diagnosis, treatment and control. The health challenge is the comprehensive organization and implementation of the response to minimize the impact on the health of the population,” the Ministry of Health stressed.

It is a sexually transmitted disease caused by the bacterium Treponema pallidum, whose main reservoir is humans, and which is acquired mainly through sexual contact with an infected person (usually through contact with infectious ulcers present in the genital region, anus, rectum, lips or mouth); by perinatal transmission via the transplacental route or during childbirth, or by blood transfusion. Sexual transmission typically occurs during primary, secondary or early latent syphilis.

Dr. Vanesa Fridman, from the Infectious Diseases Division of the Hospital de Clínicas (MN 97832), explained to Infobae that the increase is due to multiple factors ranging from “lack of information, lack of access to prevention, diagnosis and treatment services, to the lack of perception that these diseases are still present. Also due to changes in sexual practices and the persistence of stigma, among others,” said the specialist.

She added that the group where the highest number of cases is seen is young people between 15 and 35 years old, especially men who have sex with other men. Other groups where the highest prevalence is seen (key populations) are sex workers and trans people.

The bacterium Treponema pallidum, whose main reservoir is humans, is the cause of the infection.

The natural and untreated evolution of syphilis is divided into three stages:

Symptoms vary between men and women and throughout their different stages: primary, secondary, latent and tertiary, as explained by the Mayo Clinic. During the primary stage, symptoms of the disease in both genders begin with the manifestation of a chancre, which is a round, firm ulcer, usually painless, that appears where the bacteria entered the body, that is, on the genitals, rectum, lip or inside the mouth.

Because of their painless nature and often hidden location, they can go unnoticed, especially in women. In women, chancres can appear in the vagina or cervix, making them difficult to detect without a specialized medical examination.

There is a growing tendency to not take care of oneself during sexual relations – (Illustrative Image Infobae)

The secondary stage is characterized by a rash that appears while the chancre is healing or several weeks later. This rash may appear on the palms of the hands and soles of the feet, but it can spread to other areas of the body.

It is usually not itchy and may be rough and reddish brown. Wart-like lesions may also appear in the mouth, genital area or rectum, as well as other signs: fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue.

Finally, in the tertiary stage, men and women experience serious complications. Tertiary syphilis can occur years after the initial infection and can cause severe damage to several organs, including the heart, brain, liver, bones, and joints.

Symptoms include neurological problems (paralysis, dementia, gradual blindness), cardiovascular problems (aneurysms, inflammation of blood vessels), and lesions on the skin, bones, and internal organs.

Chart showing the age groups most affected by syphilis (Ministry of Health)

Data published by the BEN indicate that the populations most affected by syphilis are people between 15 and 34 years old and the highest rates are found in the population aged 20 to 29 years.

Another observation is that the greatest differences in rates by sex are observed between 15 and 34 years of age, with higher rates in females (probably related to greater accessibility to health services). And in the population over 50 years of age, syphilis notifications in males exceed those in females.

In the framework of World Condom Day, in mid-February, Infobae reported that the Adolescent Program of the Hospital de Clínicas de la UBA warned that only 5% of adolescents always use a condom during sexual relations, the safest way to avoid STIs such as syphilis.

Only 5% of teenagers take care of themselves during sexual intercourse – (Illustrative Image Infobae)

The data comes from a survey conducted by AHF Argentina, which details that when the age range is extended to young people, 13% said they always use condoms.

“I think the challenge is to make them aware of the number of sexually transmitted infections to which they could be exposed and the implications that these have on their health. Most of them are only aware of the diseases that are perhaps more popular, such as HIV, hepatitis or syphilis, but they cannot really identify the impact of these on their health or the existence of other diseases,” said Dr. María Sol Barrientos, a gynecologist who is part of the Adolescents Program at the Hospital de Clínicas de la UBA (MN 160.680).

The doctor said that although more and more teenagers are asking about methods, “they do not ask about the risks of not using barrier methods, beyond unwanted pregnancy.”

Most of the new syphilis infections are young people between 15 and 34 years old (Getty)

“We now have the task of fighting against the myths that emerge on social media, where there is a lot of misinformation about contraceptive methods in general and sometimes people rely on sources that do not have medical information. That is why comprehensive sexual education and the beginning of medical consultations at the beginning of puberty are so important,” said the expert.

From 2007 to 2021, syphilis notification in the general population was recorded through the National Surveillance System in a grouped manner from the following components: 1) the clinical component, with weekly grouped numerical information on syphilis cases in women and men for early syphilis events and without specifying stage; 2) the laboratory component, with weekly grouped numerical information on samples studied, and positive by non-treponemal tests (PNT) and treponemal tests (PT) in women and men.

Syphilis has been on the rise in Argentina since 1994 (Ministry of Health)

These data were taken to establish the annual incidence and the information provided by laboratories for monitoring in each jurisdiction. However, as of the update of the surveillance standards in 2022, syphilis surveillance in the general population will move to an individualized nominal modality, integrating both clinical and laboratory information.

“From 2011 to 2019, the increase in cases and rates was constant and particularly accelerated between 2015 and 2019. In 2020-2021, coinciding with the COVID-19 pandemic, there was a significant decrease in notifications, but with an even higher number of reported cases than in 2017 and previous years. From 2022, and on the occasion of the change in the notification method, which is now based on nominal records, the upward trend in cases and rates resumed, reaching a notification rate that exceeds 69 cases per 100,000 inhabitants,” the Ministry of Health notes.

Chart by region and province, of reported cases of syphilis (Min de Salud)

In the six years recorded, between 2018 and 2023, 129,620 cases of syphilis were reported to the National Surveillance System in the country. The national health portfolio stated that at the national level the increase is very different between the different regions.

While, at the country level, the rate differences between what was recorded in the 2018 notification (taken exclusively from the clinical component in the grouped modality) and what was recorded in 2023 (taken from the nominal notification, integrating the clinical and laboratory components) was 18 cases per 100,000, in the Centro region the difference between both years was only 2 cases per 100,000 inhabitants, in the Cuyo region it was 39, in the NEA region it was 46, in the NOA region it was 52 and in the Sur region it was 57.

Sex education is key to preventing STI infection (Illustrative image Infobae)

All regions experienced the highest rates of the period in 2023, except for the Central region, which had a notification rate very similar to that of 2019, when it experienced the highest rate of the period.

While in 2018 the highest notification rate was recorded in the Central region, with 61.9 cases per 100,000 inhabitants, and the lowest in the NOA region with 20.9; in 2023 the highest notification rate was recorded in the South region with 89.5 and the lowest in the Central region with 63 cases per 100,000 inhabitants.