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Syphilis in gay and bisexual men

What is syphilis?

  • Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.
  • It is passed on through sexual contact and can infect both men and women.
  • Syphilis may not cause any noticeable problems during the early years of infection – but if left untreated it may cause serious disease later in life affecting the brain, nerves, eyes, heart, blood vessels and joints.
  • Treatment at any stage will cure the infection and prevent these problems developing.
  • Syphilis increases the risk of catching HIV or passing it on to your partner.
  • If you are found to have syphilis we recommend you should have a full STI screen including an HIV test.

How common is syphilis?

  • Over the last 10 years we have seen an epidemic of syphilis in the UK with a 12 fold increase in the number of infections diagnosed.
  • The epidemic is centred in London, Manchester and Brighton.
  • Most syphilis infections (73%) occur in gay and bisexual men.
  • One third of men are also infected with HIV.

How do you catch syphilis?

  • Syphilis is passed on through:
    • unprotected anal or oral sex (or sharing sex toys) with someone that has syphilis
    • oral sex is a common route of transmission – one third of infections are passed on this way
    • direct contact with a syphilis sore or ulcer – these usually occur on the genitals but occasionally occur on lips and in the mouth
  • Syphilis is very infectious and easy to pass on during the first and second stages of infection and for about 2 years after first catching it.
  • Syphilis cannot be caught from swimming pools, saunas, toilet seats or shared clothing or eating utensils.

What would I notice if I had syphilis?

  • Most men with syphilis would not notice anything wrong until problems and complications occur 10 or more years later (tertiary syphilis).
  • There are 3 stages to syphilis infection:
    • The first stage – called primary syphilis.
    • The second stage – called secondary syphilis.
    • The third stage – called tertiary or latent syphilis.
  • A man may notice some of the following:
  • Primary syphilis
    • A single sore or ulcer that is small, round, firm and usually painless – it appears at the spot where syphilis entered the body usually the penis, lip or mouth, or around the bottom – but it can occur anywhere.
    • It occurs between 10 and 90 days after infection and lasts 3 to 6 weeks before healing without any treatment.
    • Without treatment syphilis progresses to the second stage.
  • Secondary syphilis
    • A non-red itchy rash may appear on parts of the body – it can often be very faint – it usually includes the palms of the hands and soles of the feet.
    • Swollen lymph glands.
    • Flu like illness with fever, muscle aches, headaches and tiredness.
    • Without treatment syphilis progresses to the latent or tertiary stage.
  • Tertiary or latent syphilis
    • Without treatment syphilis infection remains in the body although there may not be any external signs – this ‘latent’ stage can last for 10 –20 years.
    • Up to one third of people with latent syphilis infection may develop tertiary syphilis.
    • In tertiary syphilis serious problems arise from damage to internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.
    • Treatment for syphilis in the earlier stages of infection prevents these problems.

How do I get tested for syphilis?

  • In the clinic we can take a scraping from a syphilis sore/ulcer and examine it directly under the microscope to see if treponemes are visible.
  • A special blood test is also taken – the result will be available in 3 days.
  • If the first blood test is positive we need to do another confirmatory test.
  • Syphilis can incubate for up to 3 months before the blood test picks up the infection – so if you are worried about one particular risk then we may need to repeat the blood test after 3 months.
  • All specialised sexual health clinics (GUM clinics) routinely screen for syphilis – but having a ‘blood test’ with your GP or in another hospital department would not normally include a test for syphilis.
  • If you think you may be at risk for syphilis it is important to attend a sexual health clinic for testing.

How is syphilis treated?

  • Syphilis in its early stages is easily treated with one or two penicillin injections.
  • Syphilis in late stage disease needs a longer course.
  • If you are HIV positive you may need a longer course of treatment.
  • It is essential that the full course of treatment is completed.
  • For people allergic to penicillin other antibiotics can be given.
  • You must avoid sex until any sores or rashes have healed and your partner has been treated.
  • After treatment we need to see you regularly for blood tests – for up to a year – to check that the treatment has been successful.

What about my partner?

  • As syphilis is a sexually transmitted infection all current sexual partners need to be tested.
  • Your ex-partners may also need to be tested – the nurse will discuss this with you.
  • It is important you don’t have sex with your partner again until you have both been tested and completed any treatment.

What problems can untreated syphilis lead to?

  • In up to one third of untreated people syphilis progresses to late stage disease (tertiary stage) after 10 to 20 years.
  • Tertiary disease involves damage to many internal organs leading to serious problems including dementia, blindness, numbness, heart problems and even death.
  • Treatment of syphilis in the earlier stages prevents these problems.
  • Syphilis increases the risk of catching HIV or passing it on to your partner.

Will syphilis come back again after treatment?

  • It is important that syphilis is properly treated and that you are followed up to ensure your treatment has been successful.
  • But you can still be re-infected so it is important to have regular check-ups
  • Even if syphilis has been treated any future blood test for syphilis will always remain positive – in the clinic we arrange for additional tests to see if the infection is active. As long as you have completed treatment in the past and your blood test shows no active infection you will not need treatment again.

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