Safe Sex is Better Sex
What is Syphilis
Syphilis is a common and curable sexually transmitted disease caused by the spirochete Treponema pallidum. Syphilis is transmitted from person to person through skin-to-skin contact. Syphilis is easy to treat with antibiotics, but it often goes undiagnosed. Untreated syphilis can lead to serious medical consequences.
How common is syphilis?
Cases of syphilis are on the rise worldwide. The incidence is highest in women ages 20–24 and men ages 35–39. Until recently, it was most common among MSM (men who have sex with men), but now we are seeing an increasing number of cases in heterosexual men and women.
How is it transmitted?
Syphilis is passed via direct skin to skin contact. Some STDs are transmitted from skin to skin contact, and others are passed via fluid transmission. Syphilis is transmitted from when a person has direct contact with a syphilitic sore. These sores are commonly called a chancre. They can appear on the external genitals, vagina, anus, rectum, lips, or mouth. Because of the variety of locations of chancres, syphilis can be transmitted during vaginal, anal, or oral sex. Syphilis can also be passed through the placenta to a fetus during pregnancy. It is not spread through casual contact or contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs or shared clothing.
What are the symptoms?
Historically, physicians referred to syphilis as the “Great Pretender,” as it can lead to a wide variety of vague symptoms often confused for other diseases. There are three stages of syphilitic infections and each stage presents with different symptoms.
Stage One (Primary Syphilis)
During the first stage of syphilis a painless ulcer appears. These sores are commonly called a chancre. Chancres will last about ten days before resolving on its own. They can appear on the external genitals, vagina, anus, rectum, lips, or mouth. Some people will not notice the lesion because the chancres are painless. The chancre is very contagious, which allows syphilis to be transmitted during vaginal, anal, or oral sex. Because the syphilitic chancres are painless and disappear on their own, people often do not seek treatment.
Stage Two (Secondary Syphilis)
The second stage can appear up to two years after infection. Symptoms can range from vague flu-like symptoms to a non-itchy rash. Classically, the rash appears on the palms and soles. Other rashes, oral ulcers, enlarged lymph nodes, hair loss, weight loss, and fatigue are other symptoms. Syphilis can also lay latent for years during stage two, causing no symptoms al all. Syphilis is often diagnosed during this stage through routine STD screening.
Stage Three (Tertiary Syphilis)
Fortunately, tertiary syphilis is rare in today’s world. It can occur 10–30 years after the initial infection. It is known to cause neurologic disorders (neurosyphilis) but can affect many other organ symptoms are well. Historical figures such as Leo, Tolstoy, Al Capone, Guy De Maupassant, Toulouse Le Trec, Friedrick Nietzsche all suffered from neurosyphilis.
How is syphilis diagnosed?
During a physical exam, syphilis can be suspected. A painless ulcer (chancre) or signs of secondary syphilis may increase suspicious. Accurate testing requires blood testing. Most commonly, a blood test called an RPR is done. Other labs use more advanced tests such as a VDRL or a Treponemal Antibody.
How is syphilis treated?
Fortunately, syphilis is a curable STD easily treated with antibiotics. Penicillin is the most common treatment. All sex partners should be notified, evaluated, tested, and treated. This is crucial to preventing the spread of syphilis. If not, then one may be reinfected by an untreated partner or the infection spread to future partners. One should abstain from unprotected sexual contact until they and their sex partners have completed their treatment. In the US, local health departments are often involved in confirming that all partners are treated.
Who should be tested?
We recommend all sexually active individuals undergo routine STD screening unless in a stable, monogamous, long term relationship. In the US, all pregnant women are required to be tested during pregnancy. Anyone with a known partner who has syphilis should be tested. The CDC also recommends routine screening for anyone with HIV or MSM. In addition, anyone with any signs or symptoms should be tested.
Play it safe — Prevention is key
Prevention is best achieved by the use of latex condoms consistently and correctly. Condoms can significantly reduce the risk of transmission. Condoms are highly effective at preventing STDs. It is important to note that with skin-to-skin transmitted infections like syphilis, some areas of the body will still come into contact.
Water-based lubricants should be used with latex condoms to provide the most protection. If you are going to play, then play safe.
By: Dr. Jeff Livingston