Why Syphilis is a threat to health and its stigma

Often referred to as a ‘silent disease’, syphilis remains one of the most stigmatized sexually transmitted infections (STDs).

This stigma not only isolates patients but also drives them away from seeking essential medical care, perpetuating its spread.

According to Adel Botros, a specialist in dermatology and venereology in Egypt, this stigma manifests itself in heartbreaking ways.

Botros, recalling a case from ten years ago, told how the father of a newborn with congenital syphilis refused treatment out of fear and shame.

According to the World Health Organization (WHO), syphilis is a preventable and curable bacterial sexually transmitted disease (STD).

If left untreated, it can cause serious health problems, although many people with syphilis have no symptoms or do not notice them.

Syphilis is transmitted during oral, vaginal and anal sex, during pregnancy and through blood transfusions.

Syphilis during pregnancy can lead to stillbirth, newborn deaths and babies born with syphilis (congenital syphilis).

Correct and consistent condom use during sex can prevent syphilis.

Rapid tests can provide results in minutes, allowing treatment to be initiated during the same clinic visit.

Without treatment, the tertiary stage of syphilis can lead to various complications decades after infection.

At this stage, syphilis can affect multiple organs and systems, including the brain, nerves, eyes, liver, heart, blood vessels, bones and joints.

Tertiary syphilis can also cause death.

The global burden of syphilis

According to the United Nations Population Fund (UNFPA), cases of syphilis have risen from 8.8 million in 1990 to 14 million in 2019, with incidence rates increasing from 160 to 178 per 100,000 people.

In the United States, the number of cases of congenital syphilis has tripled since 2016.

Despite the global increase in syphilis cases, some regions have shown remarkable progress.

Morocco has significantly reduced the rate of congenital syphilis and by 2022, Oman will have eliminated mother-to-child transmission of syphilis, according to the World Health Organization (WHO).

These successes underscore the importance of targeted public health initiatives and dispel harmful stereotypes.

Historically, syphilis has been used to marginalize communities, especially women.

In Morocco during the French colonial period, authorities claimed that the prevalence of syphilis among local women was as high as 80 to 100 percent.

Research by public health professor Ellen Amster shows that these figures are grossly exaggerated due to incorrect diagnoses and unreliable tests.

The actual prevalence was less than 0.5 percent.

These misconceptions justified oppressive practices such as confining women to brothels under the guise of controlling the transmission of syphilis.

“Syphilis was linked to gender denial and shame around sexuality. which always ends up being a gendered shame,” explains Amster.

This legacy continues to shape attitudes towards sexual health.

Comprehensive sexual health services, including prevention, education and counseling, are critical.

Experts advocate breaking the silence around STDs to create a more inclusive and supportive environment for those affected.

The global increase in syphilis is a stark reminder of the importance of integrating human rights into public health strategies.

By tackling stigma and inequality, we can build a future where sexual health is a priority for all.

Modern health crises continue to expose the ongoing intersection of stigma, power dynamics, and public health.

The 2022 Mpox outbreak (formerly known as monkeypox) is a stark example.

Despite efforts by global health authorities to control the virus, stigma persisted, fueled by discriminatory reporting.

According to UNAIDS, media reporting often relied on images and language that reinforced homophobic and racist stereotypes, particularly against LGBTI and African communities.

Similar patterns were evident during the Covid-19 pandemic, where xenophobic narratives led to widespread anti-Asian discrimination.

Human Rights Watch documented waves of violence and exclusion, driven by unfounded fears of contagion.

Syphilis is no exception to this dynamic. Historically used as a tool to marginalize communities, it remains a symbol of shame in many societies.

The WHO notes that the disease disproportionately affects men who have sex with men, further reinforcing stigma in some communities.

Botros highlights how fear and shame continue to obscure the true burden of syphilis in regions such as the Arab states.

“The stigma that was weaponized against our region during colonial times persists,” he says.

Many patients avoid seeking care unless they have no other option, further complicating efforts to control the disease.

Towards inclusive and stigma-free healthcare solutions

Tackling infectious diseases requires confronting the biases embedded in public health responses.

Experts from UNFPA and WHO argue for the urgent need to engage, rather than alienate, affected communities.

This approach not only reduces stigma, but also improves disease surveillance and intervention outcomes.

By prioritizing equity, inclusivity, and education, modern society can challenge the power dynamics that have long hindered progress in global health, and ensure that no one is left behind in the fight against syphilis and other public health threats.