In a special series, Dr Laura Waters from Mortimer Market Centre is focussing on the main sexually transmitted infections gay men are at risk from. This week it’s Syphilis.
Syphilis is an infection transmitted mainly through sex. It has an interesting history; it was probably brought back from one of Christopher Columbus’s expeditions and the first European outbreak was in late 1400s Italy. Over the following centuries syphilis caused huge problems but its association with sex meant stigma, which meant under-reporting of cases.
Back then, with no antibiotics, late stage syphilis could be extreme and disfiguring. The actual bug was identified in 1905 but it wasn’t until penicillin was discovered in the 1940s that we had an effective treatment.
After a huge drop in cases from the 1940s, syphilis reached very low levels during the early days of the HIV epidemic (1980s), but has been going up again since. In 2017, when most other sexually transmitted infections (STIs) stayed stable, there were over 7,000 new syphilis cases, 20% more than 2016! Most cases were in gay men and half were in London; men with HIV are at particular risk.
There are different stages of syphilis, depending on how long someone has had the infection; early infection is the first 2 years, longer than that is considered late. Most syphilis in the UK is early stage; it’s fairly easy to tell if you have regular STI check-ups as the blood test changes from negative to a positive result. Sometimes, if someone has not had a recent syphilis test, it’s harder to know the infection stage so we err on the side of caution and treat as late.
Syphilis can infect the mouth, genitals, anus or rectum and is spread through direct contact – up to 1 in 6 infections in gay men are from oral sex. Condoms reduce the risk. Very early syphilis starts with a small lump that turns into an ulcer (usually painless); sometimes there will be several ulcers. Without treatment the ulcer will clear up in a couple of months, then about 1 in 4 people will develop different symptoms about 3 months after infection; most commonly a rash, often widespread and classically including the palms and soles. After the early stages, symptoms disappear; only 1 in 3 people get further complications, usually decades later.
Syphilis blood tests are included in routine STI check-ups. If you have an ulcer a swab will be taken and sent to the lab; some clinics can use a special microscope to check for syphilis immediately but many no longer do this, as other tests are more reliable. If you have had syphilis before one of the blood results will always be positive so the clinic will request a different type of test. If you don’t tell the clinic they will contact you to check if you’ve had treatment already. Syphilis is entirely curable, preferably with a pencillin injection, one dose for early syphilis and three for later stages – the injection is quite big so half has to be given into each buttock and it includes local anaesthetic to reduce pain. If you’re allergic to penicillin or can’t cope with injections there are tablet options.
You should avoid sex for 2 weeks after treatment (and if you have symptoms, when these have cleared up too). As syphilis is pretty infectious (around a 1 in 3 chance of getting it if you have sex with someone with early syphilis) clinics usually treat people who’ve had sexual contact with someone with syphilis, without waiting for test results.
What can you do to reduce your risk? Regular tests, prompt treatment and treating sexual partners. Condoms also reduce risk; campaigns to increase condom use are not very successful but it’s sensible to at least use condoms with new partners until both you, and they, have had a check-up. Since people with HIV are at particular risk, HIV clinics can probably do more – if you have HIV remember you may need STI screens more often than your routine HIV monitoring. Unfortunately there’s no vaccine against syphilis yet, and it’s likely to be a long way off…. if there are any new developments Boyz readers will be the first to know!
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every week in Boyz. If you have a question for Dr Laura please email her at [email protected]