Syphilis

Syphilis Basics 

Syphilis is an infection caused by a bacteria called Treponema pallidum. It is spread through contact with a syphilis sore (also called a “chancre”), by condomless anal, oral and front hole sex or even deep kissing. Syphilis cases have increased significantly in every major Canadian City among gay, bi and queer men in recent years.

Getting syphilis again once you’ve had it is common. Having syphilis once doesn’t give you any immunity towards getting it again. Notifying your sexual partners to get tested after you have been treated is important to avoid re-infection.

Using a condom will reduce your risk of getting syphilis again in the future. Getting tested regularly will make sure that if you do get it again, you can be treated as soon as possible.

Syphilis Stages

Syphilis can be identified in several stages:

• Primary Stage - A chancre appears on your cock, ass, fronthole or mouth. The sore is painless and can be hidden on the underside of your tongue or in your ass. You might not notice it.
• Secondary Stage - A body rash develops 2 - 12 weeks later. The rash is not usually itchy and can be so faint you don’t notice it. You may develop flu-like symptoms such as a sore throat, fever and fatigue.
• Latent Stage - The sore and rash go away. There are no visible symptoms, but syphilis is still present.
• Tertiary Stage - The bacteria affect the brain (neurosyphilis), cognition, sensory organs, heart, and blood vessels. Complications, including brain damage and death may occur after many years if left untreated.

Syphilis Treatment

The simplest and most effective treatment for the early stages of syphilis is a shot of penicillin in the butt. Since penicillin allergies are common, alternative antibiotic treatments such as doxycycline and azithromycin may be used.

After treatment, your body requires time to recover. Even if you feel better, there may still be syphilis bacteria in your body, so it’s important to test again to ensure the treatment worked fully. It is recommended you get tested three, six and twelve months after treatment.

It may take up to a week for your body to clear the infection once you’ve been treated, so it’s important to take a break from sex to avoid giving syphilis to others. If you have regular partners, make sure everyone gets treated, otherwise you can re-infect each other.

If you’ve had syphilis in the past and test for it again, notify your healthcare provider of your past diagnosis. False-positives are common: once you’ve had syphilis, anti-bodies can remain in your body that are detectable by certain tests. If you have previously tested positive for syphilis and get a Serological Test for Syphilis Enzyme Immunoassay (STS-EIA), or Treponema Pallidum Particle Agglutination Assay (TPPA), these will likely test positive for life because they detect syphilis-specific antibodies. Polymerase Chain Reaction (PCR) tests and Rapid Plasma Reagin (RPR) tests can determine if you’ve been infected again with syphilis.

Getting Tested

Syphilis is common and spreads easily, so make syphilis testing a regular part of your health checkup. The test is confirmed with a blood test or the chancre can be directly swabbed if it’s still active. For a list of sexual health clinics providing services during the ongoing COVID-19 pandemic please visit Toronto Sexual Health Clinics.

Get tested…

• Right away when you have symptoms
• Once a year if you have a small number of sexual partners
• Once every 3 months if you have many sexual partners

If you are diagnosed with syphilis, we recommend also getting tested for HIV. Having syphilis may increase your chances of getting HIV because having a sore or break in the skin, such as a chancre, may allow HIV to more easily enter your body.

HIV Positive?

If you’re living with HIV and undetectable, your treatment for syphilis is the same as someone who is HIV negative. If your HIV is untreated, however, you may require more rigorous treatment. For early stages, instead of one shot of penicillin, physicians might suggest a shot once a week for three weeks, or pills taken orally over two to four weeks.

If your CD4 count is under 350, you may be more susceptible to developing neurosyphilis. Neurosyphilis occurs in the third stage, when the bacteria affect the brain and central nervous system and can develop in people who are not treated. Neurosyphilis can lead to treatment complications and requires more and longer doses of penicillin to treat.

If syphilis advances to neurosyphilis, penicillin therapy for ten to fourteen days is recommended.