Syphilis cases increased 30% in Minnesota's gay/bi men's community in 2007.
WHAT IS IT?
Syphilis is a sexually transmitted disease (STD) caused by the spirochete (spiral-shaped) bacterium Treponema pallidum. It has historically been known as "the Pox" or "the Great Imitator", as it often mimics the symptoms of other diseases and easily goes undiagnosed.
WHY DO GAY/BI MEN NEED TO KNOW ABOUT IT?
Syphilis is easy to get, easy to miss, and easy to cure. And it's on the rise. Once all but wiped out in the U.S., syphilis is back, right here in the Twin Cities gay/bi men's community. New syphilis cases increased 30% in Minnesota's gay/bi men in 2007.
The most commonly reported risk factors among gay/bi men with syphilis in 2007 were meeting partners on the Internet, anonymous sex, and no condom use.
It is completely curable, so with symptoms that can progress to blindness, insanity and death, it's important to get tested on a regular basis and treated if infected (treatment is easiest if diagnosed within the first year of infection).
Also, syphilis makes it dramatically easier (2 to 5 times!) to both get HIV and give HIV. They tend to travel together. Often times when someone tests positive for HIV or syphilis at our clinic, they also test positive for the other within 6 months.
HOW DO I GET IT?
Syphilis, like herpes and HPV, is spread by skin-to-skin contact, making it very easy to transmit. Unprotected oral sex, anal sex, vaginal sex and rimming are easy ways to both get and give syphilis. It is especially infectious during the first year of infection, often when a person doesn't know they are infected.
Using a latex or polyurethane condom (such as the bottom condom) will help prevent transmission if used correctly, and used every time. However, if the condom doesn't cover the site of infection, transmission can still occur. This is especially tricky if someone is infected inside their mouth or inside their butt, and why unprotected oral sex is a common way of getting syphilis.
The most infectious part of syphilis is the chancre, a small, painless sore during the primary stage of infection. Mucous patches in the mouth during the secondary stage are also highly infectious. Rashes can also be the cause of a transmission.
A guy does not need to ejaculate in order for transmission to occur during unprotected sex, just skin-to-skin rubbing.
Communicate with your partners about current or previous risks for STDs, and familiarize yourself with the symptoms of syphilis.
WHAT ARE THE SYMPTOMS?
Many guys who test positive for syphilis had no idea they were infected. Syphilis is easy to miss and often goes undiagnosed. Below are the symptoms associated with the different stages of infection:
PRIMARY STAGE (2 - 12 weeks after infection)
- Single, painless chancre (a small, round sore with raised edges, doesn't hurt)
- Occasionally multiple chancres
- Chancre appears at site of infection (typically on/near the penis, scrotum, or inside the mouth, butt or vagina, depending on what type of sex you are having)
- Chancre goes away on its own in 1 - 5 weeks
SECONDARY STAGE (6 weeks - 6 months after infection)
- Rash on the palms, soles of the feet and/or on the torso/limbs
- Mucous patches in the mouth or genital mucous membranes
- Condyloma lata (moist, heaped, wart-like lesions)
- Alopecia (patchy hairloss)
- Symptoms go away without treatment
EARLY LATENT (less than 1 year after infection)
- Previous symptoms from primary and secondary stage have resolved, no current symptoms but may still be infectious
LATENT (1+ years after infection)
- No symptoms
- May progress to tertiary syphilis (gumma, cardiovascular syphilis)
NEUROSYPHILIS (can occur during any stage, Primary through Latent)
- Neurological tremors
- Loss of motor control of limbs
Left untreated, syphilis can cause serious neurological damage and can lead to death.
HOW DO I KNOW IF I HAVE IT?
Syphilis can be diagnosed by a simple blood draw. Clinicians make a diagnosis based on the results of the blood test and depend on sexual histories (number of sex partners, Internet hookups, sex partners diagnosed with early syphilis, etc.) and visual examination of symptoms. If a chancre is present, a sample may be taken and examined under a darkfield microscope on-site.
If there are neurological symptoms present, a spinal tap is required to diagnose and treat neurosyphilis. Treatment for neurosyphilis is very difficult and must be done in-patient at a hospital in consultation with an infectious disease specialist.
Syphilis is completely curable, but a person can continue to test positive after being treated so it's important to let your clinician know if you've previously had syphilis. Further testing identifies whether or not you have been re-infected with syphilis or if it's just carry-over from your previous infection.
HOW IS IT TREATED?
Syphilis is a serious disease if left undiagnosed, but is completely curable. It is easy to treat if you are HIV-negative, and if you've had the infection for less than a year.
If you are HIV-negative, early stages of syphilis (primary, secondary, and early latent) are treated with a single dose (two shots in the butt) of Bicillin L-A, a specific type of penicillin. There are no home remedies or over-the-counter drugs that cure syphilis. Follow up testing at 6 and 12 months with a clinician is required to ensure treatment success.
If you are HIV-positive, early stages of syphilis may be treated with either a single dose (two shots in the butt) or three sets of doses (two shots in the butt per week for three weeks) depending on your clinician's recommendations. Follow up testing is done at 3, 6, 9, 12, and 24 months.
If you are HIV-negative and have had syphilis for more than a year, treatment becomes more complicated. A total of three doses (two shots in the butt per week for three weeks) are required. Follow up testing with a clinician is required at 6, 12 and 24 months.
If you are HIV-positive and have had syphilis for more than a year, three doses (two shots in the butt per week for three weeks) are required. Follow up testing with a clinician is required at 6, 12, 18 and 24 months to ensure treatment success.
Alternative treatment regimens are available for people allergic to penicillin.
It is possible to be re-infected with syphilis after treatment if a person is exposed again.
For more specific information about treatment, consult your medical provider. You can also read more in the CDC's 2006 Sexually Transmitted Diseases Treatment Guidelines.
SYPHILIS AND HIV CO-INFECTION
There is a strong link between syphilis and HIV.
If you have syphilis, there is an estimated 2 - 5 times increased risk of getting or giving HIV when infected. Syphilis sores make new openings for HIV to enter our bodies, disrupting natural barriers like skin and mucous membranes that typically assist in protecting us from infection. It turns lower HIV-risk activities like unprotected oral sex into a high risk for HIV.
If you have HIV, it is much easier to get syphilis than an HIV-negative individual. Factors such as viral load and CD4 counts play a big role in a higher risk of infection for syphilis. Also, syphilis symptoms can be dramatically worse if you are HIV-positive. In fact, some HIV-positive gentlemen who contract syphilis report that they had symptoms that discouraged them from even leaving the house to receive medical care and treatment. Symptom progression and intensity is often affected by HIV infection. Furthermore, syphilis sores can bleed easily and increase the chances of passing HIV to your sex partner.
WHAT ABOUT SEX PARTNERS?
It is best to wait two weeks after treatment, but at the very least wait at least one week after treatment before having any kind of sex (oral, anal, or vaginal) to avoid infecting others and avoid becoming re-infected.
It is also important that anybody that you have had sex with in the last 6 - 12 months be notified about your infection, depending on the staging of your infection (how long you've had syphilis).
Each of your sex partners will need to be tested and treated. Do not have sex with anyone you have had sex with that has not been tested and treated.
Click here for information on how to notify your partners through InSPOT.
WAYS TO REDUCE YOUR RISK
- Use latex or polyurethane condoms every time to help prevent transmission
- Use a new condom or latex glove with each new partner in group settings
- Limit the number of people you have sex with
- Get a full STD exam on a regular (at least annual) basis, depending on your risk
- Get your partners tested on a regular basis
For more information about syphilis, check out the CDC's Syphilis & MSM Fact Sheet.
Also, check out the HIM Program's syphilis website, StopSyphilisNOW.org.
Questions about your risk? About testing? Contact the HIM Program or call us at 612.348.9100.Content updated: May 08