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Cardiovascular Syphilis
Mohammed Kallash1, William Frishman
1From the Department of Medicine, School of Medicine, New York Medical College, Valhalla, NY.
Insights
Cardiovascular syphilis, a late-stage complication, increases risks for heart attack, stroke, and death. Early penicillin treatment prevents progression, making advanced cardiovascular syphilis rare despite rising syphilis rates.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health
Background:
- Syphilis, caused by Treponema pallidum, progresses through four stages.
- Tertiary syphilis can lead to cardiovascular complications like syphilitic aortitis and aortic regurgitation.
- Recent studies link syphilis to increased risks of myocardial infarction, heart failure, stroke, and venous thromboembolism.
Purpose of the Study:
- To review the incidence and pathophysiology of cardiovascular syphilis.
- To detail current treatment options and prognosis for cardiovascular syphilis.
- To highlight the clinical significance of cardiovascular syphilis in light of recent syphilis incidence trends.
Main Methods:
- Literature review of cardiovascular syphilis manifestations.
- Analysis of population-wide studies on syphilis and cardiovascular outcomes.
- Discussion of recent trends in syphilis incidence and cardiovascular syphilis prevalence.
Main Results:
- Syphilis patients face elevated risks for acute myocardial infarction, heart failure, atrial fibrillation, ischemic and hemorrhagic stroke, venous thromboembolism, and cardiovascular death.
- Despite an 80% increase in reported syphilis cases (2018-2022), cardiovascular syphilis incidence remains stable.
- Early penicillin treatment effectively prevents progression to tertiary syphilis and its cardiovascular sequelae.
Conclusions:
- Cardiovascular syphilis, while serious, is now rare due to effective early antibiotic treatment.
- Public health efforts should focus on early syphilis detection and treatment to prevent severe long-term complications.
- Understanding the link between syphilis and cardiovascular disease remains crucial for comprehensive patient care.
Abstract:
Syphilis is a disease caused by the spirochete bacterium Treponema pallidum, progressing in 4 stages: primary, secondary, latent, and tertiary syphilis. In the tertiary stage, patients may develop cardiovascular syphilis, which includes syphilitic aortitis, aortic aneurysm, aortic regurgitation, and coronary artery involvement. These cardiovascular manifestations increase morbidity and mortality during this late stage of syphilis. A recent large-scale, population-wide study has built on our knowledge of cardiovascular syphilis by identifying an increased risk for the development of acute myocardial infarction, heart failure, atrial fibrillation, ischemic stroke, hemorrhagic stroke, venous thromboembolism, and cardiovascular death in syphilis patients. This review discusses the incidence and pathophysiology of these various manifestations of cardiovascular syphilis, while also detailing the latest treatment options and the prognosis of these conditions. The clinical significance of this topic stems from the fact that the incidence of syphilis has spiked in recent years after previously reaching an all-time low in 1999. According to the Centers for Disease Control in the United States, from 2018 to 2022, the reported cases of syphilis increased by 80%. However, the incidence of cardiovascular syphilis has remained the same during this period, likely due to the efficacy of penicillin use early in the infection, preventing the progression of the disease to the tertiary stage. As a result, cardiovascular syphilis mostly remains a disease of the past, with only a few sporadic cases being reported in the literature in recent years.
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