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Syphilis |
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Syphilis. It’s still here.
Toronto has continued to observe high rates of infectious and latent stages of syphilis.
To speak with a counsellor for information about syphilis or other STIs and where to get tested, contact the AIDS & Sexual Health InfoLine at 416-392-2437.
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What is syphilis?
Syphilis is a Sexually Transmitted Infection (STI) caused by highly contagious bacteria.
How do you get it?
For men who have sex with men, syphilis bacteria are spread through unprotected oral or anal sex (both insertive and receptive). Fingering, rimming, mutual masturbation, fisting and kissing can also spread syphilis if these activities involve direct contact with sores, lesions, semen or blood. Body fluids such as semen and blood are highly contagious for up to two years in an untreated person.
Because sexual contact involves friction, syphilis bacteria can enter the body through tiny breaks in skin or through delicate mucous membranes. In men, the mucous membranes most commonly infected are the mouth, throat, penis and anus.
Syphilis bacteria can also be passed by sharing drug gear.
Why is there a concern about syphilis now?
In Toronto, we are seeing more cases of syphilis in men having sex with men (MSM).
Since 2002, the infectious syphilis rates have dramatically increased in large Canadian, American and Western European cities, mostly among men who have sex with men. At least one third of men diagnosed with syphilis also have HIV.
Who is at risk in Toronto?
Men who have sex with men are currently more at risk for becoming
infected with syphilis. This includes men who have:
- unprotected oral or anal sex
- more than one sex partner in a year
- casual or anonymous partners, especially bathhouse contacts
What Happens When You Get It?
Primary Syphilis (first stage)
Two to four weeks after becoming infected, a person will develop a chancre, a painless sore.
It will appear where the infection got into the body. The chancre may go unnoticed because it is painless and usually heals on its own. The chancre may be mistaken for a boil, a herpes sore or mouth ulcer.
The chancre or sore usually appears:
- in or around the penis
- around or inside the anus
- on the lips or in the mouth or throat
- on the nipple, scrotum or a finger
Secondary Syphilis (second stage)
If primary syphilis is not treated, three to six weeks after the chancre has healed, a rash may appear. Sometimes the rash appears while the chancre is still present. The rash can be faint or may look like a few blemishes.
The rash can be on the:
- whole body
- palms of the hands
- soles of the feet
- genitals
- torso (chest, abdomen and back)
Other symptoms of secondary syphilis may be:
- irregular sores in the mouth or on the genitals
- flat, warty lesions, which appear in or around the anus
- flu-like symptoms (swollen glands, aching joints)
- temporary patchy hair loss
- mucous patches in the mouth
Note: secondary syphilis stage does not occur in everyone
Latent Syphilis (no symptoms)
If a person infected with syphilis is not treated in the first two stages, they will enter a phase where there are no symptoms at all. For the first one to two years after becoming infected, a person’s semen and blood will remain highly contagious. This is called early latent syphilis. After one to two years, most people will no longer be contagious. This stage is called late latent syphilis. The length of treatment will vary for these two stages.
Tertiary Syphilis
If a person is not treated for syphilis, about 10-20 years later, the infection may start to cause serious damage to the heart, eyes, bones, brain, nervous system and other internal organs. Syphilis is still treatable at this stage, but the damage done to the body may be permanent.
Note: This stage may develop much faster in HIV positive men. (Refer to the section on Syphilis and HIV in this pamphlet.)
How can you protect yourself?
The best protection for you and your partner(s) is using a latex condom every time you have oral or anal sex. However, syphilis bacteria can still come into contact with the genital area that is not covered by a condom.
How long are you contagious?
You are infectious during the first and second stage, because
there are syphilis bacteria in the chancre and rash. Body fluids such as
semen and blood may also be highly contagious for up to two years in an
untreated person.
After treatment, it is difficult to say how long a person is contagious. Most experts recommend that you have no sexual contact for at least two weeks after your last treatment.
Who should be tested for syphilis?
Get tested and/or treated as soon as possible if you have had one or more
symptoms of syphilis, or if you have been in sexual contact with someone
who has syphilis. Most places will give you an earlier appointment if you
tell them your concern. For now, stop having sexual contact until you are tested.
Men who have sex with men should have a yearly test for syphilis.
You may need to test more frequently if you have frequent sexual
contact with casual partners or use bathhouses.
Men who have been treated for syphilis should also test at regular
intervals after treatment (usually 3, 6, 12 and 24 months) to ensure the
treatment has worked, and to detect any possible re-infection.
How do you get tested for syphilis?
The standard test for syphilis is a blood test. A sample is taken from the
arm. Results are usually ready 7-10 days later. If there is a chancre, the
doctor may take a swab for testing.
How is syphilis treated?
Syphilis is treated with antibiotics, usually injections of a long-acting form
of penicillin. If you are allergic to penicillin, other antibiotics in pill form
may be used. The amount and length of treatment will depend on the stage
of syphilis. Some men who are HIV positive may be given a longer
treatment. Once treated, you can be re-infected by someone who is infected with syphilis. Treatment is provided free of charge
Are there any side effects to treatment?
Several hours after treatment with penicillin, some people may develop what
is called a “Jarish-Herxheimer” reaction. This reaction includes fever, chills,
headache and muscle and joint pain. These symptoms usually disappear in
24 hours. You can take acetaminophen (Tylenol) to help reduce the
discomfort.
What about Syphilis and HIV?
What if you have HIV?
Men with HIV may have weakened immune systems that make them more
likely to pick up bacterial infections, such as syphilis. Symptoms of syphilis
might be more severe and may progress quickly to the later stages. The
infection may take longer to treat and cure. Syphilis may increase viral loads
of HIV. In other words, syphilis can quicken the rate at which HIV damages
your immune system.
An HIV positive person with syphilis may also be more contagious: the immune system may be less able to control the amount of syphilis bacteria in the body.
Doctors do not routinely test HIV positive men for syphilis, you should specifically ask your doctor for a test.
Does syphilis increase the risk of HIV infection?
Yes, because syphilis causes sores and rashes, it is easier to get infected with
HIV during sexual activity. This means there is a greater risk of passing
HIV from an HIV positive man to an HIV negative man if either of them also has syphilis. When a person has an infection like syphilis or any other Sexually Transmitted Infection (STI) there is an increase in the number of white blood cells in the infected mucous area. HIV can attach to these cells and pass directly into the blood. This makes a man 3-4 more times likely to become infected with HIV if his sexual partner is infected with syphilis.
What about my sexual partners?
If a doctor says you have:
- primary syphilis, inform all sexual partners for the 3 months before the symptoms developed
- secondary syphilis, inform all sexual partners for the last 6 months before the symptoms developed
- early latent stage, inform all partners for the last 1 year unless you had proof of a previous negative test
- late latent stage, inform all long-term sexual partners
If you need help telling your partner(s), Toronto Public Health can notify them without giving your name. You can call 416-338-2373 for help.
What to do? Where to go?
Contact your family doctor or the STI clinic in your area. STI clinics are free clinics for Toronto residents including individuals without health insurance as well as for visitors and can provide free STI medications. For more information and to find a STI clinic near you, call the AIDS and Sexual Health InfoLine at 416-392-2437 or visit www.toronto.ca/health.
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