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A Disease for the Ages

Robbins, Noah MD, CM, FACP, FIDSA

Infectious Diseases in Clinical Practice: July 2019 - Volume 27 - Issue 4 - p 185
doi: 10.1097/IPC.0000000000000754
Editorial Comment

From the Department of Medicine, Albert Einstein College of Medicine, and the Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY.

Correspondence to: Noah Robbins, MD, CM, FACP, FIDSA, 3400 Bainbridge Ave, Bronx, NY 10467. E-mail:

The author has no funding or conflicts of interest to disclose.

Written as an editorial commentary regarding Pinto et al. Syphilis Screening Practices of Family Care Providers pages 201–204 of the Journal.

“Do not hope to see the end of the scourge that is afflicting you. This disease shall be eternal.”1

The optimism at the turn of the 21st century, when the incidence of primary and secondary syphilis fell to all-time lows and eradication seemed possible (at least in the United States), has been shattered by the harsh reality that this disease is not going away anytime soon. In 2017, 30,644 new cases were reported to the Centers for Disease Control and Prevention, a 10.5% increase over the previous year.2 Disturbingly, the 2017 incidence of congenital syphilis rose 43.8% compared with 2016 and 153.3% compared with 2013.

Syphilis may never be eliminated, but it is eminently curable. Treponema pallidum is still susceptible to penicillin, even after more than 75 years of use. The Centers for Disease Control and Prevention recommends that health care providers routinely obtain sexual histories from their patients to assess behavioral risk for infections such as syphilis.3

With this as background, Pinto and colleagues4 conducted a cross-sectional survey consisting of 27 questions about demographics and syphilis screening practices administered to primary care physicians, nurse practitioners, and physician assistants located in central Pennsylvania. Fifty-two providers responded to the survey. Cutting to the chase, inquiries into sexual practices were most likely to occur during well-woman visits or visits prompted by genitourinary symptoms. Asymptomatic men were only rarely queried, despite the fact that nearly 90% of new cases of syphilis occur in men (and more than two-thirds occur in men who have sex with men).2

In an era in which federal funding for sexually transmitted diseases clinics has been cut substantially, the burden for screening is falling increasingly on family care providers. It is incumbent on us, as infectious diseases specialists, to get the word out to them, if we are to make further progress toward elimination of what Fracastoro presciently called an eternal scourge nearly 500 years ago.

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1. Morbus Gallicus. A Translation in Prose of Fracastor’s Immortal 1530 Poem. St Louis, MO: The Philmar Company; 1911:55.
2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Human Services; 2018.
3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64 (No. RR-3):2–3.
4. Pinto CN, Sneeringer K, Muller A. Syphilis screening practices of family care providers. Infect Dis Clin Pract. 2019;27(4):201–204.
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