SYPHILIS

For a long time people thought that syphilis had practically been eliminated in Europe and North America but for a number of years now the number of reported cases of infection has dramatically increased. In Canada too there has been an alarming upswing in the infection rate. Current statistics show a huge increase in infection, particularly among men who have sex with men.

On the other hand , a great many gay men seem to have no awareness of this infection which is mainly transmitted through sex, or they tend to downplay its seriousness and the risk of infection through contacts on the gay scene or in the private sphere.

On the up side syphilis is relatively easy to treat. But if you wait around before getting treatment it can lead to very serious consequences for own health and generally means that you will pass on the infection to your own sex partners.

We've collected the main points you should know about syphilis in the question and answer format below.

How can I catch syphilis?

The short answer is very easily, sorry to say. Getting infected with the syphilis bacterium is a lot easier than getting infected with HIV (the virus that causes AIDS).

Syphilis is transmitted through contact of the bacterium with the skin or mucous membranes (linings) of the genital area, mouth or anus.

No kind of sex is syphilis-safe but transmission via the mucous membranes is a lot easier than transmission through unbroken skin.

This is why most infections in gay men appear on the glans (tip) of the penis or on the penis shaft, in the anus or rectal passage and in the mouth or throat and much less seldom on the fingers or the hand though such cases are also known to occur.

Syphilis is also known as the great imitator because its early symptoms are similar to those of many other diseases. In addition, the first symptoms disappear without any treatment within the first few weeks, which means that many cases are simply not recognised or recognised too late when the infection is in an advanced stage and risks becoming chronic. Protection against this is offered with treatment with suitable antibiotics.

How do I recognise the first syphilis symptoms?

About three weeks after the time of infection a moist ulcer the size of a ten cent coin may appear on the place of infection. Although it may appear, it does not necessarily appear! When it does, this ulcer is completely painless yet highly infectious this is the period when syphilis can be transmitted through simple contact or rubbing.

Generally the ulcer clears up without any need for treatment. Because of its small size and the fact that it generally appears on parts of the body that are awkward or impossible to see, it often goes completely unnoticed.

In this primary stage of the disease the appearance of the ulcer - or what the medical experts call the primary effect – can be accompanied by swollen lymph glands.

What are the further stages?

If the primary stage goes untreated, within around two to six months after the time of infection the secondary stage develops with general symptoms like an attack of flu. You feel sick, get a mild fever and have pains in your joints. You can also get a brown rash all over your body and your lymph glands become so swollen they can be felt. At the same time a rash of brown, wart-like sores (papules) may appear in the mouth, and on the cock and ass.

This rash will disappear after a few weeks without any treatment, but it can reappear at any time, particularly on the palms of the hands and the soles of the feet. Sometimes it leaves discoloured patches of skin behind. It's often associated with patchy loss of hair. In this stage all bodily fluids can be infectious.

When this secondary stage is over, the syphilis may lapse into a latent stage without any symptoms which can last for years or even decades.

The earliest tertiary stage is about two years after the time of infection. In this third stage syphilis damages the inner organs like the heart, blood vessels and nervous system. About one third of people who have had untreated secondary syphilis go on to develop the complications of third stage syphilis.

This stage is characterised by the appearance of inflamed cancerous growths called 'gumma' which can appear anywhere in the body in the skin, in bones, in internal organs, in blood vessels or the central nervous system. As they destroy the body tissue in the place where they appear, they can lead to a wide variety of complications. They can also result in cardiac complications, including heart attacks and chronic arterial diseases.

The fourth and final stage of syphilis mainly occurs after ten to twenty years when the disease starts to damage the brain and the nervous system. The symptoms in this final stage include progressive paralysis, acute pain, blindness and disorientation, and mental illness resulting in death.

All the symptoms associated with the various stages of the disease can appear but must not necessarily do so! Single stages can go by completely unnoticed or can even be 'skipped', because the progress of syphilis varies enormously from person to person. And this particularly true of people with HIV (see below).

I'm not sure if I've got syphilis. What should I do?

The best thing to do is to go to your doctor or a healthcare center and ask for a syphilis test. A simple blood sample is all they need for diagnosis. The diagnosis can also distinguish between a fresh infection and one that's considerably older.

The rate of syphilis infection among urban gay men has shown a remarkable increase (in some areas over 40% up!) so it's really advisable for men with one of two sex partners a month to take a syphilis test every three months. All other sexually active men should take a test every six months or at least once a year.

What kind of treatment will I get?

If syphilis is diagnosed early on, treatment is simple. In the primary stage, treatment involves a course of penicillin injections in the buttocks which usually lasts from two to three weeks. Later stages can also be treated with penicillin but the treatment is much longer and a stay in hospital for a course of infusions will also be necessary. Plus complications to inner organs caused by the disease cannot be reversed. So it's obviously better to start treatment as soon as possible!

How can I protect myself and others from syphilis?

Avoid any kind of contact with open cuts and wounds! Condoms and rubber gloves can reduce the risk of infection but cannot completely eliminate it. Dildos and other sex toys should either be used by one person alone or should be thoroughly disinfected before being used with another partner.

Information, awareness and early, full and proper treatment are the three factors that can lead to a sharp drop in the rate of new infections. If you find you're infected, it's absolutely vital that you inform all your sex partners so they can take a test and get early treatment if necessary. And until the treatment course is really finished and you get a clean bill of health from your doctor or healthcare provider, you really should abstain from sex.

Does syphilis increase the risks of infection with HIV?

Yes it does! If you're HIV positive and also have syphilis, then it's much easier to transmit HIV to your sex partners via the syphilis sores. If your sex partner has syphilis (or another sexual transmitted disease) then it's much easier for him to get HIV than via unbroken skin or mucous membranes. Protecting yourself and others from the risk of HIV infection is another reason why it's vital to get treatment for your syphilis very early on.

If I'm HIV positive what special things should I watch out for in connection with syphilis?

Blood samples from HIV positive people don't always show a clear syphilis antibody diagnosis. So it's important that you get the test carried out by a competent doctor or healthcare provider who is specialised in HIV and syphilis. What's more, the course of syphilis can run much quicker with people who have an HIV immune system deficiency and the third or tertiary stage (see above) can happen much more rapidly. Plus there are also special precautions to be taken in treating syphilis in someone who's HIV positive. That's another reason why it's so important for people who are HIV positive to seek out a doctor who is specialised in both HIV and syphilis.

PLEASE REMEMBER: People with HIV/AIDS need special kinds of syphilis treatment and if syphilis is not treated it will make much quicker progress than in people without HIV/AIDS. If you are diagnosed with syphilis and you don't know your HIV status, it makes sound sense to take an HIV test. Talk to your doctor or healthcare provider about this.

Frequently Asked Questions (FAQ's) and answers about Syphilis

Q: Penicillin is freely available in Canada. Hasn't that taken care of syphilis?

A: Sad to say, it hasn't. The infection rates for syphilis have risen dramatically in the past few years and show no sign of abating especially in the urban centers. It's a sad fact but it's getting much easier to catch syphilis than many people realise. Obviously the risk is at its most intense in places where a lot of sex takes place like darkrooms, saunas, porno cinemas, and sex parties.

Q: I know all my sex partners personally because I meet them on the Internet, and I never have sex in darkrooms or saunas. So aren't I really minimizing the risks of catching a sexually transmitted disease?
A: No you're not! Just because you know your sex partners doesn't mean that they couldn't have syphilis or some other STD. And even if you ask your partner if he's got an STD doesn't mean to say that what he tells you is really up-to-date.

Q: If I get syphilis then won't I be sure to notice it?

A: That ain't necessarily so! The symptoms of syphilis can be blatant or latent or might not show themselves at all. That's why, if you're sexually active with changing partners (at least two a month), it's important to take a syphilis test once every three months.

Q: Syphilis isn't as serious as breaking your leg is it?

A: True enough! Even so, syphilis still remains a serious infectious disease that will lead to life-threatening consequences if it's not treated early on.

Q: Nowadays nobody talks about sexual transmitted diseases any more are they really as widespread as all that?

A: The simple answer is yes they are! It's a sad fact but many people are still reluctant to talk about STD's because they feel embarrassed or ashamed of them.

But feeling sorry for yourself or wasting your time with useless self-recrimination won't help one bit. On the contrary, you should feel downright glad when your sex partner tells you he has syphilis, because he's given you the opportunity to do something about it straight away. And likewise you should get in touch with all your sex partners immediately if you're diagnosed with an STD. It's the only way to work quickly and effectively to curb the new infection rate of syphilis and other STD's and to keep the fun and pleasure in sex!