Editing Syphilis (section)

==Epidemiology==
{{Main|Epidemiology of syphilis}}
[[File:Syphilis world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.4|Syphilis deaths per million persons in 2012
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[[Image:Syphilis world map - DALY - WHO2004.svg|thumb|upright=1.4|[[Age adjustment|Age-standardized]] [[disability adjusted life years]] from syphilis per 100,000&nbsp;inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=Disease and injury country estimates |year=2004 |publisher=[[World Health Organization]] (WHO) |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009}}</ref>
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In 2012, about 0.5% of adults were infected with syphilis, with 6&nbsp;million new cases.<ref name=New2015/> In 1999, it is believed to have infected 12&nbsp;million additional people, with greater than 90% of cases in the [[developing world]].<ref name=ST10/> It affects between 700,000 and 1.6&nbsp;million pregnancies a year, resulting in [[miscarriage]]s, [[stillbirth]]s, and congenital syphilis.<ref name=Wood09/> During 2015, it caused about 107,000 deaths, down from 202,000 in 1990.<ref name="GBD2015Death" /><ref name=Loz2012/> In [[sub-Saharan Africa]], syphilis contributes to approximately 20% of [[perinatal death]]s.<ref name=Wood09/> Rates are proportionally higher among [[Recreational drug use|intravenous drug users]], those who are infected with [[HIV]], and men who have sex with men.<ref name="Coffin2010"/><ref name="Gao2009"/><ref name="Karp2009"/> In the United States about 55,400 people are newly infected each year {{as of|2014|lc=y}}.<ref>{{cite web |title=Syphilis |url=https://www.niaid.nih.gov/diseases-conditions/syphilis |website=www.niaid.nih.gov |date= 27 October 2014|access-date=7 August 2019 |archive-date=7 August 2019 |archive-url=https://web.archive.org/web/20190807014149/https://www.niaid.nih.gov/diseases-conditions/syphilis |url-status=live}}</ref> [[African American]]s accounted for almost half of all cases in 2010.<ref>{{cite web|title=STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis|url=https://www.cdc.gov/std/stats10/tables/trends-table.htm|publisher=[[Centers for Disease Control and Prevention]] (CDC)|date=22 November 2010|access-date=20 November 2011|url-status=live|archive-url=https://web.archive.org/web/20120124104622/http://www.cdc.gov/std/stats10/tables/trends-table.htm|archive-date=24 January 2012}}</ref> As of 2014, syphilis infections continue to increase in the United States.<ref name="ClementOkeke2014">{{cite journal |last1=Clement |first1=Meredith E. |last2=Okeke |first2=N. Lance |last3=Hicks |first3=Charles B. |title=Treatment of Syphilis |journal=JAMA|volume=312|issue=18|pages=1905–17|year=2014|issn=0098-7484|doi=10.1001/jama.2014.13259|pmid=25387188|pmc=6690208}}</ref><ref>{{cite book |last1=Cantor |first1=Amy |last2=Nelson |first2=Heidi D. |last3=Daeges |first3=Monica |last4=Pappas |first4=Miranda |title=Screening for Syphilis in Nonpregnant Adolescents and Adults: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation |series=U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews |date=2016 |publisher=Agency for Healthcare Research and Quality (US) |pmid=27336106 |url=https://www.ncbi.nlm.nih.gov/books/NBK368467/ |access-date=5 August 2019 |archive-date=8 March 2021 |archive-url=https://web.archive.org/web/20210308105501/https://www.ncbi.nlm.nih.gov/books/NBK368467/ |url-status=live}}</ref> In the United States as of 2020, rates of syphilis have increased by more than threefold; in 2018 approximately 86% of all cases of syphilis in the United States were in men.<ref name=NEJM2020/> In 2021, preliminary CDC data illustrated that 2,677 cases of congenital syphilis were found in the population of 332 million in the United States.<ref>{{cite news |last1=Paperny |first1=Anna Mehler |title=Syphilis cases in babies skyrocket in Canada amid healthcare failures |url=https://www.reuters.com/business/healthcare-pharmaceuticals/syphilis-cases-babies-skyrocket-canada-amid-healthcare-failures-2023-03-31/ |website=reuters|date=31 March 2023 }}</ref>

Syphilis was very common in Europe during the 18th and 19th centuries.<ref name=Music08/> [[Gustave Flaubert|Flaubert]] found it universal among 19th-century Egyptian prostitutes.<ref>{{cite book|author1=Francis Steegmuller|title=Flaubert in Egypt, A Sensibility on Tour|date=1979|publisher=Chicago Review Press, Incorporated |isbn= 9780897330183}}</ref> In the developed world during the early 20th century, infections declined rapidly with the widespread use of [[antibiotic]]s, until the 1980s and 1990s.<ref name=Music08/> Since 2000, rates of syphilis have been increasing in the US, Canada, the UK, Australia and Europe, primarily among men who have sex with men.<ref name=ST10/> Rates of syphilis among US women have remained stable during this time, while rates among UK women have increased, but at a rate less than that of men.<ref name=AOP08>{{cite journal |last=Kent|first=ME|author2=Romanelli, F |title=Reexamining syphilis: an update on epidemiology, clinical manifestations, and management|journal=Annals of Pharmacotherapy|date=February 2008|volume=42|issue=2|pages=226–36|pmid=18212261|doi=10.1345/aph.1K086|s2cid=23899851}}</ref> Increased rates among heterosexuals have occurred in China and Russia since the 1990s.<ref name=ST10/> This has been attributed to unsafe sexual practices, such as sexual promiscuity, prostitution, and decreasing use of barrier protection.<ref name=ST10/><ref name=AOP08/><ref>{{cite journal |last=Ficarra|first=G|author2=Carlos, R |title=Syphilis: The Renaissance of an Old Disease with Oral Implications|journal=Head and Neck Pathology|date=September 2009|volume=3|issue=3|pages=195–206|pmid=20596972|doi=10.1007/s12105-009-0127-0|pmc=2811633}}</ref>

Left untreated, it has a mortality rate of 8% to 58%, with a greater death rate among males.<ref name=Kent08/> The symptoms of syphilis have become less severe over the 19th and 20th centuries, in part due to widespread availability of effective treatment, and partly due to [[virulence]] of the bacteria.<ref name=Sec2010/> With early treatment, few complications result.<ref name=Pri2008/> Syphilis increases the risk of HIV transmission by two to five times, and coinfection is common (30–60% in some urban centers).<ref name=Kent08/><ref name=ST10/> In 2015, [[Cuba]] became the first country to eliminate mother-to-child transmission of syphilis.<ref name=WHOCUba2015>{{cite web|url=https://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/|title= WHO validates elimination of mother-to-child transmission of HIV and syphilis in Cuba|publisher= [[WHO]]|date= 30 June 2015|access-date= 30 August 2015|url-status= dead|archive-url= https://web.archive.org/web/20150904154356/http://who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/|archive-date= 4 September 2015}}</ref>