A medieval disease is making a comeback in England - and cases have quadrupled in Merseyside over the last decade.
Cases of syphilis, the ancient sexually transmitted disease, increased by 15% to nearly 8,700 diagnoses in England last year - the largest annual number since 1948. In Merseyside, cases increased by 70%, from 90 infections in 2021 to 153. That is the highest number since 2018.
Over the last 10 years, the trend has generally seen syphilis infections increase in Merseyside - apart from a slight fall in 2019 and then a bigger decrease during the pandemic. They are now four times higher than they were a decade ago, in 2012, when just 38 infections were diagnosed
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The vast majority of recent cases (97) were diagnosed in Liverpool where the infection rate was 20.0 cases per 100,000 of the population, easily the highest in Merseyside and well above the national average. You can see the number and rate of syphilis infections where you live, and how that compares with the rest of the country, using our interactive map.
The UK Health Security Agency (UKHSA) says cases of syphilis have fluctuated over the last 100 years in England, spiking after the two world wars, but then declining in the late 1940s and 1950s due to effective treatment with penicillin and the greater availability of condoms.
It re-emerged in the 1960s but then fell into decline in the 1980s, probably due to behavioural changes brought about by the emergence and awareness of the HIV virus and Aids. But since the early 2000s syphilis - and gonorrhoea - have re-emerged as major public health concerns.
A decade ago there were 3,000 cases of syphilis diagnosed in England, just over a third as many as last year, while the infection rate has trebled from 5.6 syphilis cases per 100,000 of the population in 2012 to 15.4 last year.
Consultant Epidemiologist at the UK Health Security Agency (UKHSA) Dr Hamish Mohammed said: “Increased testing is likely to have played a part in the rise in gonorrhoea and syphilis diagnoses, but the scale of the increase strongly suggests that there is more transmission of these STIs within the population. There is some evidence to suggest that this may be due to more people having condomless sex with new or casual partners.”
UKHSA data shows syphilis disproportionally affects gay, bisexual, and other men who have sex with men (GBM). Seven in 10 of cases diagnosed last year (69%) were in GBM. Syphilis is far more common in London than anywhere else in England.
The infection rate in the capital is 44.9 infections per 100,000 of the population. That is more than triple the next highest regional rate in the North East (14.8).
And 16 of the 20 local authority areas with the highest rates of infection are in London. Syphilis is most common in Lambeth (143.3 infections per 100,000 of the population), followed by Southwark (133.2) and Westminster (128.2).
Outside London, the highest rates are in Brighton and Hove (53.9), Salford (45.4), Middlesbrough (44.5), and Manchester (42.9). Syphilis was first documented in Europe 500 years ago during the French invasion of Naples in 1495.
Because it was believed to have been spread by invading troops, it was known in some parts of Europe - including the UK - as the “French disease”. Mindful of the stigma, the French, however, called it “the Neapolitan disease”.
It is thought up to five million people died across Europe during that outbreak which left victims with bursting boils and rotting flesh. But, while one theory is that the disease was brought to Europe by Christopher Columbus’s crew on their return from the New World, scientists have found signs that a subspecies of treponema pallidum - the bacterium that causes syphilis - was present in Europe as far back as the 12th century.
Today syphilis is perfectly treatable. Symptoms include ulcers and white or grey warty growths on the genitals or bottom, sores in other areas, including the lips, mouth, and hands, a rash, flu-like symptoms, swollen glands, and possibly patchy hair loss on the head, beard, and eyebrows.
In extreme cases, it can cause serious and potentially life-threatening complications, if left untreated. But these are rare. The latest government figures show 30 deaths were caused by syphilis in England between 2013 and 2021.
The UKHSA said condoms are the best form of defence against sexually transmitted infections such as syphilis. It urges anyone having condomless sex with new or casual partners to undergo testing, which is free, and can be accessed at sexual health clinics.
To find your nearest sexual health clinic visit here.
