An outbreak of syphilis has affected the Fajardo region, especially the island city of Vieques, with 13 active cases.
The information was revealed by Dr. Melissa Marzán, chief epidemiology officer of the Department of Health, who warned that one of the dangers of the outbreak is the potential increase in the pregnancies of infected women who may transmit the infection to their children.
“This year, 14 cases of congenital syphilis have been identified,” said Marzán, emphasizing that the annual average of these cases is seven to nine, which shows progress.
The Centers for Disease Control and Prevention (CDC) defines syphilis as a sexually transmitted disease (STD) caused by a particular type of bacteria. In congenital cases, the infection is transmitted from mother to child during pregnancy.
There is treatment for this disease, Marzán emphasized, after explaining that the cases of congenital syphilis known are the result of women who do not have prenatal care or only at the beginning of pregnancy. This, he said, prevents them from getting treatment in time to prevent the child from being infected.
Meanwhile, in the outbreak identified in Vieques, 24 sexual contacts have been identified. Health did not provide more information about these cases, which are mandatory to report to the agency and which remain under investigation.
For syphilis purposes, an outbreak is declared when active cases exceed those reported in the previous three months. In Vieques, the 13 active cases so far are the first documented this year.
In early November, the CDC reported that cases of children born with syphilis in the United States will increase 10-fold between 2012 and 2022, and are part of a “rapidly spreading epidemic” that is having a greater impact. of Hispanics, African Americans and natives. ..
“The recent outbreak of men-on-men sex is marked by a high rate of coinfection with the Human Immunodeficiency Virus (HIV) and high-risk sexual behavior (such as having sex without a condom, new or multiple partners, and substance abuse) . ),” says the CDC.
In the case of Puerto Rico, Marzán established that epidemics can be the result of a series of factors. Among them, he mentioned the development of new sex practices, such as anonymous sex or between people who connect through dating applications and have sex without knowing each other.
Among the cases reported to Health, the epidemiologist warned that one in three men infected with syphilis was reported to have an unknown sex, while the proportion of women was one in 10.
“This is a practice that has never been seen before (on the island),” the official said.
Another possibility, he said, is that people taking PrEP (pre-exposure prophylaxis) – drugs that reduce the chance of contracting HIV through sex or intravenous drug use – are not using protection or condoms. their intercourse, which puts them at risk of contracting STDs.
“This is under debate because these cases (people on PrEP) have a lot of medical follow-up. Some (of the increase in syphilis cases) can be attributed to this, but not all because (These patients) need to be followed (in treatment) and that includes using condoms,” he said.
He stressed, however, that unprotected sex is the main cause of various forms of intercourse that put people at risk of STD infections.
This year, until November 14, there have been 1,179 cases of syphilis identified, 14 of congenital syphilis and 922 of gonorrhea, another STD that also shows an increase in cases in the country.
According to Marzán, between 2018 and 2020, 1,500 cases of syphilis and gonorrhea were reported. Between 2021 and this year, he added, 2,200 of them were registered, showing an increase.
“In the case of syphilis, 66% of the cases are in men. Most of the reported cases are from the Metro region, mostly in the youth groups between 20 and 29 years old,” he revealed.
According to Health data, the five municipalities with the highest incidence of cases are San Juan, Bayamón, Carolina, Caguas and Toa Baja.
“Exchanging sex for drugs or money (transactional sex), and having sex with people who inject drugs, is rare in both groups (men and women),” maintains the Health STD Surveillance Report, published on June 16. in November.
According to this document, the main mode of transmission of syphilis cases in Puerto Rico is male-to-male sex, followed by heterosexual intercourse. Intercourse between couples contacted through the Internet and the unknown sex are the other main forms of contagion.
The appearance of skin ulcers at the initial site of infection (genitals, anus and mouth), and rashes on the trunk and extremities, are the most frequent initial symptoms of primary, secondary and early syphilis. In cases of late syphilis, other complications may arise, such as cardiovascular diseases, etc. In addition, it increases the risk of contracting HIV.
“There are preventive measures, such as through routine testing (for STDs),” said Marzán, who emphasized that there is treatment for these diseases.
Of the gonorrhea cases reported this year, the highest number are among men and women between 20 and 29 years old. The five cities with the most cases are San Juan, Carolina, Bayamón, Caguas and Trujillo Alto.
Meanwhile, one in five men and one in 10 women infected with gonorrhea in 2023 reported having sex anonymously or with strangers.
According to Health, symptoms associated with gonorrhea in women include unusual discharge, spotting and swelling of the vulva. In men, the most common manifestations are urethral discharge, pain during urination, and redness and swelling of the urethral opening. Pharyngitis and conjunctivitis are other symptoms associated with this infection, which is sometimes asymptomatic, especially in women, which can increase the risk of infertility, spontaneous abortion and ectopic pregnancy. Likewise, untreated gonorrhea in men causes severe pain and swelling of the testicles and can lead to infertility.