Interesting Times

Syphilis in the Q-City

I thought syphilis went out of style long ago. What does it matter today?

We are seeing a rise in syphilis since 2002, even an epidemic according to health experts’ standards. And the majority of the cases are among gay men. This disease had practically disappeared from Denver in the mid 1990’s. The numbers of cases are not huge, but when you consider the potential for this disease to spread among sexually active gay men, the health implication is huge.

So how do you get it? I mean, we know about wearing condoms and all…

To get syphilis bacteria (Treponema pallidum), it is only necessary to be in contact with an infected person’s open sore, which may not be where you thought you would find it. The likelihood of actually getting syphilis if you are exposed to a partner with an open sore may be as high as 30 percent!

But we do wear condoms….!!

The bacteria are pretty clever about getting into a break in your skin – be that on your lips, nipples, fingers, butt, shaft of the penis, base of the penis, head of the penis, scrotum, or beneath the foreskin on a penis, - you get the picture. But let’s think beyond the usual too, it is just as happy to infect mucous membranes as well: think mouth, throat, and anal canal. A sore, called a chancre (pronounced ‘shank-er’) then appears at the sight of entry on your person.

If it gives you a sore, don’t you know that you’ve got it?

Well, this initial chancre is not sore at all, in fact it’s painless. So you may not have noticed the sore in your throat, or anal canal, or hidden beneath your foreskin. Or any of the aforementioned places on your partners’ body either, for that matter.

So what happens if you have syphilis?

Untreated, syphilis can progress through several stages – called primary, secondary, tertiary. (Go to Stages to read more about them) Sores, rashes, fevers, joint pain are a few of the symptoms. Your care provider can help you sort that out. The real problem is that there may be no signs or symptoms at all. So for many people, the only real way to tell is to be tested. Remember that this disease has a long history of causing disease in humanity – centuries of success.

Stages:

  • Primary stage: this happens after the initial exposure and the syphilis bug has an opportunity to incubate for about 3 weeks, and this stage can last 2-6 weeks. It is usually defined by that chancre at the sight of entry. Although the chancre is the result of your body fighting the bacteria in that location, the bacteria has already spread through out your body. The chancre will heal within two to six weeks, but the disease does not go away unless it is treated!
  • Secondary: About half of infected patients will have symptoms appear from two to twenty four weeks after the initial ulcer heals. Symptoms include a rash which can be on the trunk, arms, legs, hands (including palms) and feet (including soles), joint pain, and muscle pain.
  • Tertiary Syphilis occurs in two thirds of patients following the secondary stage. In the U.S., most people will get some kind of care by now, so fewer dire consequences are seen here than in poorer parts of the world. Syphilis in the nervous system, including the brain, (known as neurosyphilis) results in gradual loss of mental capacity and personality changes, loss of position sensation results in staggering, other damage results in loss of motor function and joint problems.

How is Syphilis treated?

Syphilis is still susceptible to penicillin. The number of doses and the method will depend on the stage in which the disease is discovered; your care provider will determine this. The treatment can be anywhere from a one-time injection to a series of injections to intravenous administration over days or weeks. If you’re allergic to penicillin, there are acceptable alternatives.

What happens if you have HIV?

Syphilis and HIV seem to have a great partnership: the presence of syphilis sores on either sex partner makes it easier to transmit the HIV virus. The suppressed immune system that comes with HIV may allow a faster progression of symptoms and stages or more severe symptoms.

So what can we do?

What can a person do? President Bush wants me to tell you that abstinence from sex is the best policy. I hate to agree with him, but it is, if you think about it: if you’re not baiting that hook you’re not likely to catch that big fish. For the sake of the discussion, though, let’s just pretend that maybe abstinence doesn’t work for you.

Here are a few things to help:

First: do use a condom; it will protect the area that is covered. Use it especially if you are putting it into somewhere you cannot see, like an anus, or deep in a throat.

Second: reduce the number of sex contacts. This doesn’t have to mean have less sex, just fewer partners. That may mean stay home! If reducing partners is a problem for you, your care provider can help you develop a plan to help you identify ways you can do this or contact us here at Q-City and we may be able to help.

Third: Turn the lights on and Look. Okay, even experienced care providers are challenged by syphilis, but it would be a pity to become infected from someone with an obvious chancre. Please think more than twice about it if you see a sore!

Fourth: Get tested and get treated if you’ve got it, and get your partner to treatment if he or she has it.

Fifth: remember it is important to let your care provider know about your sexual activity. Sexually active people should be checked every year, symptoms or not.

If you are in a strictly monogamous relationship, syphilis may not be a worry for you. Remember though that monogamous means that BOTH PARTNERS never have sex with anyone else. For more information you can contact us here at Q-City or visit the Sexually Transmitted Disease Clinic at Denver Public Health, 605 Bannock. Monday-Friday 8-4:30 pm, call for directions and more details: 303-436-7200.

Q-City Tip: If you are sexually active with multiple partners get tested for syphilis at least once a year or if you have any signs or symptoms that are worrisome more often. Remember syphilis is easy to test for and easy to treat and cure!

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