Los médicos saben desde hace mucho tiempo que la sífilis puede dañar permanentemente la visión y la audición de una persona e incluso puede causar cambios psiquiátricos, pero estos síntomas generalmente se asocian con infecciones que no han sido diagnosticadas ni tratadas durante años.

En un nuevo estudio presentado el miércoles en la Conferencia del Servicio de Inteligencia Epidémica (EIS, por sus siglas en inglés) 2024 en Atlanta, los investigadores dicen que el año pasado hubo más de dos decenas de casos con este tipo de síntomas en Chicago, y casi un tercio de los casos se encontraban en las primeras etapas de su desarrollo. infecciones.

• Las tasas de sífilis materna en Estados Unidos se triplicaron en los últimos años 

Más de dos tercios de estos pacientes (68%) carecían de síntomas típicos de sífilis, como sarpullido o chancro, que podrían alertar a los médicos sobre la infección.

“Los proveedores definitivamente necesitan realizar más pruebas de detección y ser conscientes de que esto es lo que estamos viendo”, dijo la autora principal del estudio, la Dra. Amy Nham, funcionaria de EIS de primer año, o “detective de enfermedades”, asignada al Departamento de Chicago de Salud Pública.

Los casos de sífilis están aumentando en todo Estados Unidos. En 2022, se notificaron más de 207.000 casos de sífilis, la cifra más alta desde la década de 1950, según los Centros para el Control y la Prevención de Enfermedades de EE. UU. (CDC, por sus siglas en inglés).

Los hombres que tienen relaciones sexuales con hombres tradicionalmente han tenido la mayor carga de sífilis en EE.UU., y eso sigue siendo cierto; pero en los últimos años, la demografía de la infección ha ido cambiando, y las infecciones se han más que duplicado en hombres y mujeres heterosexuales desde 2019. La sífilis congénita, en la que la infección se transmite de una mujer embarazada a su bebé, también está aumentando.

Nham dijo que sus supervisores del Departamento de Salud Pública de Chicago le pidieron que investigara casos con síntomas inusuales (llamado sífilis NOO, por neurosífilis, sífilis ocular y sífilis ótica) después de escuchar que los proveedores de toda la ciudad estaban atendiendo más de ellos.

La doctora Amy Nham buscó en un depósito de registros médicos de toda la ciudad para buscar casos de pacientes que tuvieran signos o síntomas compatibles con la sífilis NOO y 28 personas cumplieron con su definición de caso. La mayoría (75%) eran hombres y negros (71%). Los pacientes tenían edades comprendidas entre 23 y 82 años. Seis eran hombres homosexuales, pero aproximadamente la mitad dijeron que eran heterosexuales. Uno de cada tres era VIH positivo, que era un porcentaje menor de lo que Nham dijo que esperaba, dado que las personas que viven con VIH generalmente tienen síntomas más graves de sífilis. Según los últimos datos de los CDC, más de un tercio de los hombres homosexuales con sífilis primaria y secundaria también tenían VIH.

El estudio de Nham encontró que los síntomas más comunes que experimentaban los pacientes eran dolor de cabeza, cambios de personalidad o alteración del estado mental y problemas oculares como pérdida de visión, sensibilidad a la luz o hinchazón del ojo.

“No son los síntomas más específicos, por lo que es realmente importante que los proveedores realicen pruebas de detección adecuadas y pregunten a los pacientes sobre los factores de riesgo” y cosas como su historial sexual, dijo Nham.

La sífilis es causada por una bacteria llamada Treponema pallidum. La infección progresa en etapas. Las personas lo contraen cuando entran en contacto con una llaga redonda, firme e indolora llamada chancro, que suele aparecer en los genitales, los labios o la lengua. El chancro marca la primera etapa de la infección. Estas llagas pueden durar de 3 a 6 semanas y eventualmente pueden desaparecer por sí solas, sin tratamiento. A veces, es posible que las personas no los noten porque pueden ser pequeños o estar en un lugar difícil de ver.

La sífilis es una infección astuta. Sus síntomas van y vienen y pueden parecerse a los de muchas otras dolencias, lo que lleva a los médicos a apodarlo “el gran imitador”.

Una vez que el chancro desaparece, puede parecer que la infección ha desaparecido, pero simplemente se ha ocultado. La segunda etapa de la infección suele comenzar con erupciones o lesiones en la boca. Las personas también suelen sentirse mal: pueden tener fiebre, inflamación de los ganglios linfáticos, fatiga, dolor de garganta, dolores musculares, caída del cabello y pérdida de peso.

La sífilis puede progresar a una tercera etapa si no se trata. La tercera etapa surge entre 10 y 30 años después de la infección inicial y puede ser fatal.

En cualquier momento de la infección, la bacteria puede invadir el sistema nervioso y afectar el cerebro, los ojos y los oídos. Esto puede incluir dolores de cabeza, inflamación del cerebro llamada meningitis, accidentes cerebrovasculares y cambios mentales. Los ojos pueden estar sensibles a la luz o hinchados, o la vista puede verse afectada. Las personas también pueden experimentar pérdida de audición, mareos o tinnitus si la infección llega a sus oídos.

El estudio de Nham solo analizó Chicago, pero ella ha estado recopilando informes de casos y dice que los médicos están viendo cosas similares en otras partes del país.

Dijo que no sabe con seguridad por qué están viendo más casos con estos síntomas atípicos (eso estaba más allá del alcance de su estudio), pero tiene algunas teorías.

El tratamiento preferido para la sífilis es una inyección de una forma de acción prolongada del antibiótico penicilina, llamada Bicillin L-A, que ha estado en escasez durante un año.

Debido a que las inyecciones son el único tratamiento eficaz durante el embarazo, los CDC han aconsejado que los proveedores de atención médica den prioridad a esas inyecciones para las personas embarazadas y los bebés.

Los hombres pueden tomar un antibiótico diferente (doxiciclina) para curar sus infecciones. Pero la doxiciclina es una pastilla que debe tomarse dos veces al día durante varias semanas para que sea efectiva, y algunas personas no terminan el tratamiento completo, lo que puede permitir que la infección arda y empeore.

“Podría haber simplemente un aumento en el número de pacientes no tratados o tratados de forma inadecuada, lo que está causando resultados más graves de sífilis”, dijo Nham.

Doctors have long known that syphilis can permanently damage a person's vision and hearing and can even cause psychiatric changes, but these symptoms are usually associated with infections that have gone undiagnosed and untreated for years.

In a new study presented Wednesday at the Epidemic Intelligence Service (EIS) 2024 Conference in Atlanta, researchers say there were more than two dozen cases with these types of symptoms in Chicago last year, and nearly one-third of the cases were in the early stages of development. infections.

Rates of maternal syphilis in the United States tripled in recent years 

More than two-thirds of these patients (68%) lacked typical syphilis symptoms, such as rash or chancroid, that might alert physicians to the infection.

“Providers definitely need to do more screening and be aware that this is what we're seeing,” said the study's lead author, Dr. Amy Nham, a first-year EIS, or “disease detective,” officer assigned to the Chicago Department of Public Health.

Syphilis cases are on the rise across the United States. In 2022, more than 207,000 cases of syphilis were reported, the highest number since the 1950s, according to the U.S. Centers for Disease Control and Prevention (CDC).

 Men who have sex with men have traditionally had the highest burden of syphilis in the U.S., and that remains true; but in recent years, the demographics of infection have been changing, with infections more than doubling in heterosexual men and women since 2019. Congenital syphilis, in which the infection is passed from a pregnant woman to her baby, is also on the rise.

Nham said her supervisors at the Chicago Department of Public Health asked her to investigate cases with unusual symptoms (called NOO syphilis, for neurosyphilis, ocular syphilis and otic syphilis) after hearing that providers across the city were seeing more of them.

Dr. Amy Nham searched a citywide repository of medical records for cases of patients who had signs or symptoms consistent with NOO syphilis, and 28 people met her case definition. The majority (75%) were male and black (71%). Patients ranged in age from 23 to 82 years. Six were gay men, but about half said they were heterosexual. One in three was HIV-positive, which was a lower percentage than Nham said he expected, given that people living with HIV generally have more severe symptoms of syphilis. According to the latest CDC data, more than one-third of gay men with primary and secondary syphilis also had HIV.

Nham's study found that the most common symptoms patients experienced were headache, personality changes or altered mental status and eye problems such as vision loss, light sensitivity or swelling of the eye.

“These are not the most specific symptoms, so it's really important for providers to screen appropriately and ask patients about risk factors” and things like their sexual history, Nham said.

Syphilis is caused by a bacterium called Treponema pallidum. The infection progresses in stages. People contract it when they come in contact with a round, firm, painless sore called a chancre, which usually appears on the genitals, lips or tongue. The chancre marks the first stage of infection. These sores may last 3 to 6 weeks and may eventually go away on their own, without treatment. Sometimes, people may not notice them because they may be small or in a hard-to-see place.

Syphilis is a sneaky infection. Its symptoms come and go and can resemble those of many other ailments, leading doctors to dub it “the great imitator.”

Once the chancre disappears, the infection may appear to be gone, but it has simply gone underground. The second stage of infection usually begins with rashes or lesions in the mouth. People also often feel unwell: they may have fever, swollen lymph nodes, fatigue, sore throat, muscle aches, hair loss and weight loss.

Syphilis can progress to a third stage if left untreated. The third stage arises 10 to 30 years after the initial infection and can be fatal.

At any time during infection, the bacteria can invade the nervous system and affect the brain, eyes and ears. This can include headaches, inflammation of the brain called meningitis, strokes and mental changes. The eyes may be sensitive to light or swollen, or vision may be affected. People may also experience hearing loss, dizziness or tinnitus if the infection reaches their ears.

Nham's study only looked at Chicago, but she has been collecting case reports and says doctors are seeing similar things in other parts of the country.

She said she doesn't know for sure why they are seeing more cases with these atypical symptoms (that was beyond the scope of her study), but she has some theories.

The preferred treatment for syphilis is an injection of a long-acting form of the antibiotic penicillin, called Bicillin L-A, which has been in short supply for a year.

Because the shots are the only effective treatment during pregnancy, the CDC has advised that health care providers prioritize those shots for pregnant people and infants.

Men can take a different antibiotic (doxycycline) to cure their infections. But doxycycline is a pill that must be taken twice a day for several weeks to be effective, and some people don't finish the full course of treatment, which can allow the infection to flare up and get worse.

“There may simply be an increase in the number of untreated or inadequately treated patients, which is causing more severe syphilis outcomes,” Nham said.

Doctors have known for a long time that syphilis can permanently damage a person's vision and hearing, and can even cause psychiatric changes, but these symptoms are usually associated with infections that have gone undiagnosed and untreated for years. 

In a new study presented Wednesday at the 2024 Epidemic Intelligence Service (EIS) Conference in Atlanta, researchers say that last year there were more than two dozen cases with these types of symptoms in Chicago, and nearly a third of the cases were in the early stages of their infection development. Maternal syphilis rates in the United States have tripled in recent years. 

More than two-thirds of these patients (68%) lacked typical symptoms of syphilis, such as rash or chancre, that could alert doctors to the infection.

"Providers definitely need to conduct more screening tests and be aware that this is what we are seeing," said the study's lead author, Dr. Amy Nham, a first-year EIS officer or "disease detective" assigned to the Chicago Department of Public Health. 

Syphilis cases are rising across the United States. In 2022, more than 207,000 cases of syphilis were reported, the highest number since the 1950s, according to the U.S. Centers for Disease Control and Prevention (CDC). 

Men who have sex with men have traditionally borne the highest burden of syphilis in the U.S., and that remains true; however, in recent years, the demographics of the infection have been changing, with infections more than doubling among heterosexual men and women since 2019. Congenital syphilis, where the infection is transmitted from a pregnant woman to her baby, is also on the rise. 

Nham said that her supervisors at the Chicago Department of Public Health asked her to investigate cases with unusual symptoms (called NOO syphilis, for neurosyphilis, ocular syphilis, and otic syphilis) after hearing that providers throughout the city were seeing more of them.

Dr. Amy Nham searched a citywide medical records repository for cases of patients who had signs or symptoms consistent with NOO syphilis, and 28 people met her case definition. Most (75%) were men, and 71% were black. The patients ranged in age from 23 to 82 years. Six were gay men, but about half reported being heterosexual. One in three was HIV positive, which was a lower percentage than Nham said he expected, given that people living with HIV generally have more severe symptoms of syphilis. According to the latest data from the CDC, more than one-third of gay men with primary and secondary syphilis also had HIV. 

Nham's study found that the most common symptoms patients experienced were headaches, personality changes or altered mental state, and eye problems such as vision loss, light sensitivity, or swelling of the eye. 

'They are not the most specific symptoms, so it is really important for providers to conduct appropriate screening tests and ask patients about risk factors' and things like their sexual history, Nham said. Syphilis is caused by a bacterium called Treponema pallidum. The infection progresses in stages. 

People contract it when they come into contact with a round, firm, and painless sore called a chancre, which usually appears on the genitals, lips, or tongue. The chancre marks the first stage of the infection. These sores can last from 3 to 6 weeks and may eventually disappear on their own, without treatment. Sometimes, people may not notice them because they can be small or in a hard-to-see location. 

Syphilis is a cunning infection. Its symptoms go away and return, and they can resemble those of many other ailments, leading doctors to nickname it 'the great imitator.' 

Once the chancre disappears, it may seem that the infection is gone, but it has merely hidden itself. The second stage of the infection often begins with rashes or lesions in the mouth. People also commonly feel unwell: they may have fever, swollen lymph nodes, fatigue, sore throat, muscle aches, hair loss, and weight loss. 

Syphilis can progress to a third stage if left untreated. The third stage emerges between 10 and 30 years after the initial infection and can be fatal. 

At any time during the infection, the bacteria can invade the nervous system and affect the brain, eyes, and ears. This can include headaches, inflammation of the brain called meningitis, strokes, and mental changes. The eyes may be sensitive to light or swollen, or vision may be affected. People may also experience hearing loss, dizziness, or tinnitus if the infection reaches their ears. 

Nham's study only analyzed Chicago, but she has been gathering case reports and says that doctors are seeing similar things in other parts of the country. 

She said she doesn't know for sure why they are seeing more cases with these atypical symptoms (that was beyond the scope of her study), but she has some theories. 

The preferred treatment for syphilis is an injection of a long-acting form of the antibiotic penicillin, called Bicillin L-A, which has been in short supply for a year. 

Because injections are the only effective treatment during pregnancy, the CDC has advised healthcare providers to prioritize these injections for pregnant people and babies. 

Men can take a different antibiotic (doxycycline) to cure their infections. However, doxycycline is a pill that must be taken twice daily for several weeks to be effective, and some people do not complete the full treatment, which can allow the infection to linger and worsen. 

'There could simply be an increase in the number of untreated or inadequately treated patients, which is causing more severe syphilis outcomes,' said Nham.