Syphilis renaissance: Truth or mirage. Analysis of syphilis trends and possible factors from a tertiary care centre in North India

Background Syphilis has shown a recent resurgence globally, including in India. However, inconsistency in the data and diagnostic criteria used, especially in India and developing countries, hinders ideal understanding. Factors responsible for this surge need to be explored. Objectives This study aimed to assess the trends and describe the clinicodemographic characteristics of syphilis cases seen in a tertiary care health centre from Northern India. Methods This is a retrospective chart review of syphilis patients registered in our sexually transmitted infection (STI) clinic spanning 13 years from January 2011 to December 2023. Complete demographic details, sexual history, clinical examination and laboratory investigations of all syphilis cases, including associated STIs, were retrieved. Results The retrospective analysis included 2000 records, of which 324 were confirmed syphilis cases (16.2% of total STI cases). Patients' mean age was 30.9 ± 9.9 years, of which 80.9% were male and 64.2% were married. Education level varied, with professionals comprising 22.2% of the total cohort. Premarital and extramarital exposure were present in 35.8% and 32.7% patients, respectively; over half (56.8%) reported multiple partners and 13% were homosexual. There was an initial plateau in the number of confirmed syphilis attending the clinic (2011-2019), a decrease during 2020-2021 due to COVID and significant increase from 2022 onwards. Latent syphilis was the most common (66.7%), followed by secondary (18.8%) and primary (8.9%). In all, 36.1% of syphilis patients had associated STIs, with human immunodeficiency virus (HIV) infection being the most prevalent (25.0%). Limitation Retrospective nature of the study is major limitation. Rising trend needs validation with population-based studies to establish if the rise is true or a shadow phenomenon. Conclusion A resurgence of syphilis cases has appeared in the past two years, with latent syphilis contributing to the majority of cases. Possible factors for the surge include changing sexual behaviour, including male having sex with male (MSM), early adolescent sexual exposure, increased screening for latent syphilis, increased healthcare accessibility post-COVID-19 pandemic, and HIV co-infection.