Syphilis: Get tested. Get treated. Tell your partners.
What’s up with syphilis?
We've seen a dramatic increase in infectious syphilis over the past 12 years in Toronto. Today the number of new syphilis cases is eighteen times higher than in 2001.
Most (97%) of these cases of infectious syphilis have been among men. Over 80% of these have been among gay and bisexual men. And, almost 1/2 of cases in 2012 were among men who were also HIV-positive.
It's important to get tested - and treated - as syphilis is much easier than HIV to get or pass on. If you are HIV-positive, syphilis can make you very sick, very quickly.
Syphilis is here. And it’s not nice. If you get syphilis, it can be very serious. But there are things you can do to protect yourself and others.
What is syphilis?
Syphilis is a sexually transmitted infection (STI) that is caused by bacteria. It is easily transmitted during sexual activity. It goes through three different stages after infection, with different symptoms at each stage.
How is syphilis spread?
It’s spread when your skin -- especially mucous membranes like those found in your mouth, throat, penis, ass, frontal genital area (for trans guys) and the top inside of your nose -- comes into direct contact with syphilis sores or rashes. It can be spread through oral sex (sucking or getting sucked), anal sex (fucking or getting fucked), frontal/vaginal sex, and any other sexual activities that may involve contact with syphilis sores, or with semen (cum) blood or frontal/vaginal fluids.
Sharing injection, smoking and/or snorting drug use equipment, can also pass syphilis from one person to another. Trans guys should take note that sharing needles to inject hormones is also considered a high risk activity.
How do I know if I have syphilis?
You may have syphilis and not know it. While some people develop visible symptoms of syphilis infection, others don’t. Depending on where you are having sex, you might not be able to see if your sex partner has symptoms of syphilis. Symptoms or not, if you have syphilis you can still get very sick and give syphilis to others.
Stages of syphilis infection:
- About three weeks (any where from 10 – 90 days) after you have sex with someone who has syphilis, you may develop a painless sore (called a ‘chancre’) on your penis, near your anus (ass, bum), in your throat, or for trans guys, the frontal genital area. You may or may not notice that you have a chancre. The sore may go away by itself after 3-6 weeks; however you are still infected with syphilis. It’s very easy to pass on syphilis to someone at this stage of infection. This is referred to as the "primary" stage.
- Four to 10 weeks after the chancre appears, you may notice a red rash on your chest, palms, genitals, or the soles of your feet. You might also have muscle and joint pain, fever and patchy hair loss. These symptoms may also disappear without treatment, but you can still pass on syphilis to sexual partners. This is referred to as the "secondary" stage.
- If syphilis isn’t treated in the secondary stage you can still pass it on to sex or drug partners for a year from the time you got syphilis, even though you don’t have any symptoms. This is referred to as the “early latent” stage.
- Finally, there is a long period without any symptoms. However, the syphilis bacteria continue to live in your body and can cause serious damage to your heart, brain, eyes and bones. It may take from 10 to 30 years before this damage is seen but can occur much earlier if you also have HIV. Fortunately, syphilis can be detected and treated before it reaches this stage. This stage is referred to as the “late” or “tertiary” stage. It is less likely that you will pass on syphilis to someone at this stage of infection. Of great concern has been the appearance of cases of tertiary syphilis among those who are HIV-positive, within a very short period of time (six months after infection with syphilis, as opposed to 10 to 30 years).
Undiagnosed syphilis is a lifetime infection and if ignored, has very serious outcomes.
How can I find out if I have syphilis?
The most common means of detecting syphilis is through a blood test. Also, your doctor or the lab may also be able to examine fluid from the chancre under a microscope (if one is present). If you are HIV-positive, it may be more difficult to detect syphilis in your blood. In this case, your doctor should also ask for a "confirmatory" test.
Can syphilis be cured?
Yes! If it’s caught early, syphilis can be easily treated with antibiotics, usually by injections. A series of blood tests after you are treated will confirm that the treatment worked for you. It’s important to get these follow up blood tests. The treatment for syphilis is free.
How can I protect myself from syphilis?
Using a latex condom if you have anal sex,or for trans guys, frontal genital sex not only protects you from HIV transmission, but it can protect you when the condom covers up the sores caused by syphilis.
Using a condom when you have oral sex can also provide protection. There are flavoured and dry (non-lubricated) condoms available for oral sex. For sex with trans guys, there are barriers for oral sex such as dental dams or a condom cut up the side.
Don’t share injection, smoking and/or snorting drug use equipment, or share cigarettes. Trans guys should take note that sharing needles to inject hormones is also considered a high risk activity.
Get regularly tested for syphilis if you have more than one sexual partner. Talk to your doctor about your sex life and how often you should be tested for syphilis (and other STIs).
If you’ve had syphilis once, you can get it again – and again. That’s why it’s important to get tested regularly, especially if you have a lot of casual sex.
If you find out you have syphilis, it’s important to follow up with the treatment and see your health care provider for follow-up testing at three months, six months, 12 months and 24 months to ensure the treatment is effective.
If someone you had sex with tells you they have syphilis, get tested. Even if the test is negative for syphilis, you should be treated – you might be infected but the syphilis has yet to show up in the test. If you’re worried about telling a sexual partner that they may have gotten syphilis, you can contact your local public health department and they can tell them without your identity being disclosed, or you can send them an anonymous, e-card telling them to get tested using “inSPOT” (www.inspot.org) if you know their email address.
What if I have HIV?
Syphilis is spread through intimate body contact including skin-to-skin contact as well as unprotected oral, anal and, for trans guys, frontal genital sex. You can get syphilis more than once.
You might be surprised by the number and variety of symptoms syphilis can cause. If you are sexually active and feel unwell, ask your doctor about testing for syphilis.
You may have syphilis and not know it. Some people develop visible symptoms of syphilis infection, such as a sore or rash but others don’t.
Syphilis makes you more likely to transmit HIV to sex partners. Many STIs including syphilis will increase the amount of HIV in your blood, semen and for trans guys frontal genital fluids, making it easier to transmit HIV. Similarly, if you have HIV your immune system may be less able to control the amount of syphilis bacteria in your body making syphilis easier to pass along to your sex partners as well.
Syphilis infection may take longer to treat and cure.
Syphilis may increase your 'viral load' (a measure of HIV in your blood). This can speed up the rate at which HIV damages your immune system.
If your HIV is not being well-controlled through medications, and your CD4 counts are lower, this can put you at risk for getting neurosyphilis (syphilis infection of the brain or spinal cord), which can lead to dementia, lack of coordination, and stroke.
It's important to get tested regularly for syphilis. Normally, this is a blood test. Your doctor may not test you regularly for syphilis - so ask your doctor for a syphilis test. It’s easy to add syphilis testing into your routine blood work. You can also test at a clinic if you are not comfortable testing with your doctor.
If you find out you have syphilis, it’s important to get treated right away and then follow up with your doctor to make sure the treatment worked.
You may be concerned about getting tested because of concerns Public Health might contact you if you have syphilis. Whether you’re HIV positive or negative, Public Health requires that your sex partners be notified. Your partner(s) will not be given your name by Public Health. Certain healthcare providers have a legal duty to inform Public Health when you test positive for certain sexually transmitted infections (STIs). Depending on the circumstances, Public Health may let you or your doctor notify your sex partners.
Even with these concerns, it’s extremely important that you get tested and treated for syphilis. Left untreated, syphilis can cause you to get very, very ill. Syphilis will not go away if left untreated. Some symptoms may go away but syphilis will remain and can slowly cause damage to your body.
For more information about issues related to privacy and public health, visit the HIV/AIDS Legal Clinic of Ontario (HALCO).
Does syphilis increase the risk of getting or passing on HIV?
Yes. If you are HIV-negative, syphilis causes sores (chancres) and rashes, so it's easier to get infected with HIV during sexual activity. Your risk for HIV infection is increased from three to four times if your sexual partner is infected with syphilis and is also HIV-positive.
If you’re HIV-positive and you have syphilis, this can increase your ‘viral load’ (a measure of HIV in your blood). Also, the HIV tends to concentrate in syphilis chancres, increasing the risk of HIV transmission.
Where can I get a syphilis test?
You can get a blood test for syphilis from your doctor, at a Sexual Health Clinic, or at Hassle Free Men’s/Trans-identified Clinic (416-922-0566) here in Toronto. You can also call the AIDS and Sexual Health Infoline at 1-800-668-2437 to find out where you can get tested.
Download ACT's 2010 "Attack of the Cursed Syphilis" campaign poster, brochure and postcard for HIV-positive guys
Updated December 2013
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