What is Syphilis?
You might have heard a bit of noise around syphilis lately, maybe you’re even hearing of it for the first time?
It’s a very old infection (first known cases go far back as the 15th century!) that was common throughout history until antibiotics came along.
Unlike in the past, not many people know about syphilis today or what to watch out for. Around 50% of cases are asymptomatic and it can often be easily missed when there are symptoms, so testing rates have dropped.
Over the last few years and especially since COVID, we have seen a massive increase in WA syphilis cases.
How is syphilis caused?
Syphilis is caused by the bacteria Treponema pallidum and is spread through unprotected anal, oral and vaginal sex. It can also be transmitted through skin-to-skin contact with someone who has syphilis.
One of the early symptoms of syphilis are lumps called chancres. Chancres are small ulcers that are typically hard and painless and found around the genitals or other body parts where you have sex. Contact with chancres can be a way to spread the infection.
The chancres will usually go away after a few weeks, even without treatment. However, you will still remain infectious.
What are the symptoms of syphilis?
Syphilis is broken down into different stages, each with their own set of symptoms. Not everyone experiences all the symptoms, and it’s very possible for someone to have syphilis and not experience any of them.
The presence of a chancre (small, hard and painless ulcer) at the site of infection – this can be on the penis, on the vulva, inside the vagina, inside the anus, or mouth. Chancres are most commonly singular (only one). However, sometimes there can be multiple. They are typically painful and have pus in that case. A chancre typically appears 3 weeks after infection and will last between 2-12 weeks. Chancres can often be missed due to location (i.e. inside the vagina or anus) and because of the lack of pain.
Secondary syphilis symptoms usually appear 6 weeks after the symptoms of primary syphilis and resolve within several weeks. But they can reoccur. Symptoms include:
- Fever, headache, generally feeling unwell
- Swollen lymph nodes
- Red spotty rash that affects the palms, soles and/or trunk
- Hair loss
- Warty growths around the genitals and anus
Once the infection progresses past the secondary stage, it enters the latent stage which displays no symptoms. It can last anywhere between a few years and up to 30 years. Some people will spontaneously eliminate the infection and for others it will spread throughout the body and most to the tertiary stage.
Syphilis infection can progress to the heart, nervous system, eyes, ears and skin. It can lead to mild to severe damage in the areas it spreads to. Thankfully we have access to treatment and testing in Australia so we don’t see a huge amount of tertiary syphilis cases.
Syphilis and Pregnancy
As rates of syphilis have been rising in WA, one of the things we are most worried about is congenital syphilis. This is when a pregnant person has syphilis and passes it on to the fetus.
Congenital syphilis infection is a serious matter and can result in miscarriage, preterm birth, low birth weight, stillbirth or death soon after birth, as well as sepsis and physical malformations.
We’re lucky here in Australia that syphilis is one of the routine tests done early in pregnancy, but it is still out there. GPs might not think to test for it and expecting mums might not know to ask for a test.
Treatment during pregnancy is safe for the mother and baby, and seeking treatment as soon as possible leads to better outcomes.
Getting tested for syphilis
You can’t always look at a symptom and go “oh yep, that’s syphilis’, as often they are mild and may be confused for something else like the flu. The only way to know is by getting tested.
50% of syphilis cases are asymptomatic, which is why it is important to include testing of syphilis are part of routine sexual health checks.
Even if you don’t have symptoms, make sure your doctor includes syphilis when you get an STI screening. Syphilis can be picked up in a simple blood test. If you have a chancre, you can also get that swabbed.
You should get tested for syphilis if:
- You’re worried you might have it
- You’ve had a sexual partner who has been diagnosed with syphilis
- You have symptoms of syphilis
We recommend testing every 3 months if you have multiple sexual partners. It’s also a good idea to wait for your results (only a few days!) before you have sex again in case you accidentally pass it on.
Getting treatment for syphilis
Treatment varies depending on what stage of a syphilis infection you are at, but most of the time it’s an intramuscular injection of antibiotics or a course of oral antibiotics if you can’t have the injection.
Depending on the stage, you might need only one injection or a series of injections to properly deal with the infection
And if you are receiving treatment, talk with your healthcare provider about when you can have sex. You might still be infectious and need to wait a bit before you get back in the game.
Syphilis is not like chickenpox. You can still get syphilis again. Condoms are great for prevention, but they’re not always completely foolproof. Regular testing is our best hope in bringing the numbers down.
Let your partners know
If you’ve found out that you’re positive for syphilis, you’re going to have to let your partners know. Contact tracing is soooo important.
Anyone you’ve had sex with in the past 3 months for primary syphilis, and 6 months for secondary syphilis needs to be notified so they can also get tested and potentially treated.
But don’t stress! Doctors and nurses are able to assist you with this. Let Them Know is a service that lets you anonymously notify our sexual partners that they may have been exposed.
Syphilis and PrEP
While Pre-Exposure Prophylaxis (PrEP) is great for preventing HIV, it does nothing to prevent other STIs. If you are taking PrEP and want to avoid syphilis, condoms are still your best option.
It’s important to have open and honest conversations with sexual partners about how you both want to protect yourselves. Sex can come with a lot of pleasure but it also has its risks. You can still have an amazing time while still protecting yourself and your sexual partners from STIs.
Syphilis and HIV
If you are HIV positive and on treatment, you are not at a higher risk of contracting syphilis, but you may find that syphilis symptoms progress at a faster rate. All the more reason for keeping up with routine health screening if you are positive and staying on treatment.
If you are positive and you aren’t on treatment, then your CD4 count is usually lower, making you more vulnerable to infections like syphilis and other STIs.
If you’re not sure of your HIV or syphilis status, get a test and find out. You can easily add a syphilis test on while you’re at it, it’s only blood sample for both tests.
Syphilis is back
Syphilis is back out there and it’s not discriminating. Infections have increased 23% in last year.
One of the things we know is that it is spreading through different communities. It doesn’t matter your gender, sexuality, race, culture or relationship status. We’ve seen syphilis cases connected between different groups so it’s important to use protection, get tested and get treatment if you need it.
We have great medicine and treatment on our side, so let’s send this bacteria back to history, not back to our future!