Can Syphilis be Prevented?

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Syphilis rates have increased 76 percent since 2013 and without a dramatic increase in federal funding public health advocates fear the trend will continue.

But there is one common drug on the market right now that could turn the tide against syphilis – doxycycline.

“It’s been talked about in STD meetings. There have been whole debates on it. Journals have written about it,” said Jeffrey D. Klausner, Professor of Medicine and Public Health at UCLA. “So it’s emerging from under the radar. But there is not a whole lot of awareness yet. It’s definitely something people should know about.”

So far one clinical trial in France has shown promising results, according to one of the people who conducted the study, Jean-Michel Molina, Head of the Infectious Diseases Department at the Saint-Louis Hospital in Paris.

Molina, while cautiously optimistic, warns against reading too much into the results of the study just yet. He believes more studies need to be conducted before any conclusions are made.

“We were surprised by results,” he said. “They were quite dramatic.”

The trial only included men who have sex with men currently taking PrEP, the once a day pill to prevent HIV. The results showed a 47 percent reduction in acquiring a bacterial STD while it showed an even greater protection against just syphilis.

Besides the clinical trail a survey was conducted in the UK in July that showed those taking doxycycline reduced the chances of acquiring a bacterial STD by 50 percent.

Molina explained that unlike PrEP for HIV, which uses antiviral drugs, doxycycline is an antibiotic.

“With antibiotics its really tricky, and you have to be careful,” he said.

Overuse or misuse of antibiotics can create drug resistant strains of bacterial infections. For instance, public health advocates have been concerned about gonorrhea since the STD has been showing resistance to antibiotics for many years now. They’ve been especially worried about a drug resistance “Super Gonorreha” making its way to the U.S. Earlier this year the first case of this super bug was reported in the UK. Molina believes that’s why his clinical trial had no effect on gonorrhea noting how quickly the STD can mutate.

Even without super bugs the U.S. still has a major problem with STDs.

A recent report from the Centers of for Disease control showed in 2017, about 2.3 million cases of STDs were diagnosed. That number includes 30,644 cases of primary and secondary syphilis – a 76 percent increase since 2013.

Adam Sukhija-Cohen, the Director of Advocacy and Policy Research for the AIDS Healthcare Foundation, said public health officials went from “plans to eliminate (the STD) to a public health crisis. This is an insane resurgence.”

While there are many factors involved in why STD rates are increasing one of the major reasons is the decrease in federal funding to combat rising STD rates.

“This is a public health emergency,” said Jeffrey D. Klausner, Professor of Medicine and Public Health at UCLA. “But most concerning is a lack of a federal response. We’ve not seen any response from the secretary of health and human services’ office.”

Matthew Prior, Director of Communications for the National Coalition of STD Directors concurred that a federal response is needed to address the growing epidemic. His organization is calling for a 70 million dollar increase in STD prevention.

Despite the STD epidemic Molina doesn’t see doxycycline as the answer.

“This is not the strategy to take in the long term,” he said. “We might use this strategy for a short period of time. For instance in an outbreak in a well defined population.”

Instead Molina said more money should be directed toward researching a vaccination for syphilis.

For now though Molina believes the benefits outweigh the risks – namely creating a resistant strain of syphilis. The main treatment for syphilis has always been penicillin and it is still highly effective, Monlina said. So far no penicillin resistant strains have emerged. But some strains of syphilis have shown resistance to azithromycin, the second drug of choice when treating the STD.

“We don’t want to jeopardize the second line of treatment,” he said. “The data was interesting, but the risk of resistance [is real].”

According to an article from the American Society of Microbiology azithromycin was once thought to be the most promising alternative to penicillin in treating syphilis. But in some countries, namely Chin, syphilis resistance to macrolides (a class of antibiotics that include azithromycin) has become widespread.

The limited study Molina conducted did not show any resistance to doxycicline but he said more studies need to be conducted before any conclusions can be made. He said other researchers around the world are interested in conducting studies including some in the U.S. According to the national database of clinical trials there is one starting soon in Australia.

“I know people have already started to get these drugs,” he said. “I worry about the consequences.”

This is a third part of a series of reports SFGN will publish on the rising STDs rates in the U.S. Visit SFGN.com/STDseries to read all of them.