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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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Infectious Syphilis on the Rise in Toronto -
Information for Health Care Providers
Infectious syphilis is on the rise in Toronto. There were almost ten times as many cases of syphilis in 2004 in Toronto than was reported in 2001 (2001 = 30 cases; 2004 = 300 cases). The majority of these cases are in men who have sex
with men (MSM) including contact in bathhouses, with the rest being
related to immigration from or travel to an endemic area. This increase
is similar to trends being seen in other parts of Canada, the United
States and Europe.
What is Syphilis?
Syphilis is a complex sexually transmitted disease caused by the bacteria
Treponema pallidum. The primary stage of syphilis is usually marked
by the appearance of a painless genital ulcer or chancre, on average
21 days after infection. This chancre lasts 3-6 weeks and usually
resolves on its own. Secondary syphilis is characterized by a diffuse
rash appearing 4-10 weeks after the chancre. These symptoms will also
resolve on their own. Late or tertiary syphilis appears 10 to 20 years
later and is characterized by serious heart, brain and bone disease.
A person with untreated syphilis is most infectious in the first year.
HIV infected persons who have early syphilis may be at increased risk
for neurologic complications.
How is Syphilis diagnosed?
Darkfield examinations and direct fluorescent antibody tests of lesion
exudate or tissue are the definitive methods for diagnosing early
syphilis. A presumptive diagnosis is possible with the use of two
types of serologic tests: a) nontreponemal tests - VDRL or RPR, and
b) treponemal tests - FTA-ABS and MHA-TP. The non-treponemal tests
are used to screen individuals at risk but must be followed by treponemal
tests for confirmation of diagnosis because false-positive nontreponemal
results may occur.
It is recommended that individuals at increased risk due to multiple
or high risk sexual contacts (including men who have sex with men,
commercial sex work and street involvement) be screened every three
to six months with VDRL or RPR. In persons with symptoms suggestive
of primary or secondary syphilis, both nontreponemal and treponemal
tests should be ordered for diagnostic purposes.
Interpretation of syphilis serology is often difficult, advice should
be sought from the STD Program at Toronto Public Health or a colleague experienced in
this area.
How is Syphilis Treated?
Primary, secondary and early latent syphilis is treated with Benzathine
penicillin G, 2.4 million units IM in a single dose. Doxycycline,
100 mg. BID for 14 days can be used to treat patients with penicillin
allergy; however, these patients should be closely followed as data
to support alternate therapy is limited. Late latent syphilis should
be treated with Benzathine penicillin G, 2.4 million units IM, 3 doses
at weekly intervals. Most experts recommend treating HIV-positive
patients with primary, secondary and early latent syphilis with additional
treatments (e.g., Benzathine penicillin G administered at one week
intervals for 3 weeks as for late latent disease). HIV-positive patients
with late latent syphilis or syphilis of unknown duration should have
a CSF examination prior to treatment.
Management of Sexual Partners
All sexual partners of infected persons should be identified and tested
within the following time periods:
Primary
Syphilis:
Secondary Syphilis:
Early Latent:
Late Latent: |
3
months before onset of symptoms
6 months before onset of symptoms
1 year before diagnosis
Assess long term sexual partners and children if appropriate |
Contacts
who have been exposed to early syphilis within the past 90 days should
be treated presumptively.
For more information, please call the Sexually Transmitted Disease
Program at 416-338-2373.
References:
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