Researchers Link Late-Stage Syphilis to Elevated Risks of Stroke, Heart Attack and Death in US Adults

Researchers from Tulane University and the Southeast Louisiana Veterans Health Care System found that U.S. adults diagnosed with late-stage syphilis between 2011 and 2025 faced significantly higher risks of stroke, heart attack, and death, according to a study published in *JAMA Network Open*. The retrospective analysis of hospital records in New Orleans showed that syphilis patients had nearly six times the risk of death and elevated rates of ischemic and hemorrhagic strokes compared to controls.

The study found that adults diagnosed with late-stage syphilis had a nearly sixfold increased risk of death compared with controls, with a hazard ratio of 5.80, according to the research published in *JAMA Network Open*. Syphilis patients also experienced higher rates of ischemic and hemorrhagic strokes, as well as heart attacks. Specifically, 10.3% of syphilis patients suffered ischemic strokes compared to 5.7% of controls, and 2.0% experienced hemorrhagic strokes versus 0.8% in the control group. Heart attacks occurred in 6.9% of syphilis patients, compared with 4.2% of those without the infection.

Adults diagnosed with late-stage syphilis had a nearly sixfold increased risk of death compared with controls, with a hazard ratio of 5.80, according to the research published in *JAMA Network Open*.

After adjusting for confounding factors, the risk of ischemic stroke in syphilis patients was 53% higher, with a hazard ratio of 1.53, while the risk of hemorrhagic stroke was 92% higher, with a hazard ratio of 1.92. The risk of heart attack was 31% higher, with a hazard ratio of 1.33. The study also identified a doubled risk of aortic aneurysm or dissection among syphilis patients, with a hazard ratio of 2.08, representing the second-highest adjusted hazard ratio among cardiovascular outcomes measured. Additionally, the risk of peripheral artery disease was 28% higher after adjustment.

The retrospective analysis examined electronic health records collected from January 2011 through July 2025 within a New Orleans health care system serving adults. Researchers from Tulane University and the Southeast Louisiana Veterans Health Care System conducted the study, with Eli Tsakiris, a medical student at Tulane University School of Medicine, serving as the lead author. The objective was to determine whether syphilis infection independently increased the risk of adverse cardiovascular outcomes.

The increased cardiovascular risks were primarily observed in infections lasting longer than one year. Meningovascular syphilis, a late-stage manifestation affecting the blood vessels of the brain, typically presents five to 12 years after initial infection, according to prior research cited in the study. Stroke and transient ischemic attacks (TIAs) have been documented as presenting symptoms in approximately 3% of all syphilis cases and about 10% of neurosyphilis cases. Earlier studies reported that stroke and TIA usually occur within the first 10 years of syphilis infection, while more recent data indicate an average age of 76 years for neurosyphilis patients presenting with stroke. Peak occurrences of meningovascular stroke have been reported between four and seven years after primary infection.

Syphilis cases have been rising sharply in the United States, with especially high rates in Southern states, according to the study’s authors. Cardiovascular disease remains the leading cause of death nationwide. The researchers noted that approximately 4% of patients with recurrent strokes may have underlying syphilis infection. The study is among the few large, modern population analyses investigating the association between syphilis and cardiovascular disease.

Clinically, meningovascular syphilis poses diagnostic challenges. An estimated 80% of patients with acute ischemic stroke due to meningovascular syphilis are misdiagnosed, according to prior literature referenced in the study. The condition is described as a “great mimic” of stroke, often leading to delayed or missed diagnosis. The middle cerebral artery is the most commonly affected vessel, resulting in symptoms such as weakness, sensory loss, eye deviation, and hemineglect syndrome.

Given the findings, the researchers emphasized the importance of syphilis screening for patients presenting with recurrent strokes, regardless of age or traditional stroke risk factors. Providers treating populations at high risk for syphilis should be aware of the potential cardiovascular complications associated with the infection, especially in regions with increasing case rates.