Homosexual men, women, and African Americans are at highest risk...

Syphilis infections are on the rise worldwide since 2000, especially in the population of men who have sex with men, young women, and African American populations, in the ages from 20-36.  HCP's aren't really sure why because there is SO much education on prevention of STD's being done in the world.  So, the best way to ensure that you are safe and sound is to have the knowledge of the signs and symptoms and know how to prevent the infection.  Syphilis was a heavily studied disease back in the day, known as the Tuskegee Trials (and probably one of the most horrific studies done by the US Government) where from 1932-1972 they infected a bunch of African American men from Macon County Tennessee with Syphilis and watched how their bodies reacted from the disease in the short and long term.  This study lead to laws about ethical treatment of study patients and requirements for informed consent for biomedical studies.  And, actually, in 1767 syphilis was an issue, mostly due to a lack of contraception, but one of the first true surgeons, John Hunter, infected himself to learn more about the disease, and learn to treat it.  As it ends up, a quick shot of penicillin will do the trick, but what John Hunter learned is a fascinating part of the disease; you can get a couple of days of subtle signs of infection, then they go away and you can have no symptoms at all, but still transmit the disease and have long term complications.

What is Syphilis?
Syphilis is a bacterial infection (from the bacteria Treponema Pallidum) that is spread through unprotected sex and can cause a painless sore on the genitals, in your mouth, around the anus, or rectum and direct contact with the sore will lead to infection.  It is an infection that goes in stages and early on, it can be simply treated with antibiotics to prevent the infection from spreading, but if undiagnosed over the long term it can cause cardiac (heart) and neurological (brain/nerves) problems.

What are signs and symptoms of syphilis?
Primary Stage:
The round painless sore that occurs is called a chancre and it usually pops up 10-90 days after initial infection (average is 21 days after infection) and can be one sore or multiple sores and they appear where the syphilis entered the body (so if you had anal sex with an infected partner, it will show up around the anus, etc) and usually lasts 3-6 weeks then goes away on its own without treatment.  This DOES NOT mean that the infection is gone, it just progresses to the secondary stage.  As you can see from the pictures below, some of the chancre are things you cannot miss on yourself, an others might be easier to miss...

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Secondary Syphilis:

In secondary syphilis, you get a larger rash on the skin (can be on the palms of hands, bottom of feet, back, really anywhere!) that is not itchy and consists of rough reddish brown lesions on the skin.  Sometimes the rashes are so faint that people don't even notice them, especially because they don't cause any discomfort, if it is on your back, for example, you wouldn't know that you had it unless someone pointed it out to you.  Rarely you can also have symptoms of a fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue....who doesn't have some of these symptoms sometimes, especially during high flu/cold season?  This is why syphilis can easily be overlooked.

It should also be noted that if the skin on these rashes is broken, the disease can be transmitted to another!  As well, the rashes will go away on their own, without treatment, but then lead to the latent/end stage of the disease.

Late/Latent Stage:

You are considered to have latent stage syphilis once you have had both of the previous stages and are now without symptoms of syphilis, you continue to have the syphilis infection inside your body and can last for years, but can appear 10-20 years after first infected (and trust me, people come in and they have complications from syphilis at the age of 80 without knowing that they were ever infected!!)  In these late stages you have damage to the internal organs, brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.  This can cause uncoordinated muscle movements, gradual blindness, and severe dementia that can cause death.

Pregnant Women:

WILL transmit the infection to their babies and it will cause the infection which can either cause a stillbirth OR severe infection and seizures after birth.  It requires immediate treatment of the baby.

How am I Diagnosed?

So, if you show up to your HCP and you have a chancre, we can take a swab and study it under a dark microscope and it will show the bacteria.  And, it is shown through blood tests because the body builds up antibodies against it.  So, when you go for your regular STD testing, you will be tested for it (one of the cheapest blood tests to do!)

What are the treatment options?

If you are in the early stages of infection (under a year) one intramuscular injection of (usually) penicillin (or another antibiotic based on allergies) will treat the infection.  It will kill off the current bacteria but it will not undo the damage that has been done by the bacteria already.  As well, if you have a chancre but get treatment, you still must wait until that chancre is healed until you have sex, and you need to notify all sexual partners of your syphilis infection so that they can receive treatment in case they were also infected. 

Also, just because you have had syphilis and have been treated successfully, you still are able to contract the disease again! So, please be safe and get regular STD testing.  As with most STD's, when you have one, you are at a much higher risk of contracting the HIV virus, so please use protection and get tested regularly.  AND use common sense when hooking up!  I cannot emphasize enough, if something doesn't look right on your partner, question them about it and if it looks creepy, it probably is, so don't touch it!! And if you wouldn't touch it with your bare hand, a condom will protect you, but is it worth it??

Yours in Good Health

B