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STD Spotlight: Syphilis

Post Submitted by Dr. Bruce Rashbaum

This year, the Centers for Disease Control and Prevention (CDC) marked National Sexually Transmitted Disease (STD) Awareness Month with an educational campaign called Syphilis Strikes Back. And with good reason. According to the CDC, “Once nearing elimination, national data find that syphilis is thriving. Rates are on the rise among men, women, newborns, a majority of age groups, all regions, and almost every race/ethnicity.”

Gay and bisexual men, in particular, are experiencing rates of syphilis not seen since before the HIV epidemic, which makes raising awareness of this particular STD all the more important.

What is syphilis? How is it transmitted?

Syphilis is an STD that is sometimes referred to as the “great masquerader,” because it can look like anything, present like anything, and cause serious problems if left ignored. A syphilis infection can be divided into various stages (primary, secondary, latent, and tertiary), and there are different signs and symptoms associated with each stage.

Syphilis is most commonly transmitted by coming into contact with a syphilis sore during condomless sex. It can also be transmitted via kissing and even cuddling if you or your partner has a syphilis rash, which most often appears during the second stage of an infection. If left untreated, syphilis will remain in the body and move through its various stages, during which transmission can occur. In its tertiary stage, syphilis can cause life-threatening issues, which is why routine testing and treatment is so critical.

What are the current realities of syphilis? Why should gay and bisexual men in particular take note of its rise?

Syphilis is on the rise among gay and bisexual men, which is particularly troubling since having syphilis actually increases one’s chances of contracting HIV. It’s also worth pointing out that syphilis can present very differently among people living with HIV (PLWH) – many of whom are gay and bisexual men. Among PLWH, the first signs of a syphilis infection might actually appear during the secondary or tertiary stage (instead of during the primary stage, as is more often the case with HIV-negative individuals). Syphilis can also be much more difficult to treat among PLWH.

What prevention and/or treatment strategies exist for combating the spread of syphilis?

Condoms remain an important STD prevention strategy, and they can be very helpful in preventing the spread of syphilis. That said, it’s important to remember that syphilis sores can occur in areas not covered by a condom, and that contact with these uncovered sores can result in transmission.

The good news is that syphilis can be cured with routine antibiotics given to you by a knowledgeable healthcare provider. However, treatment might not undo any damage already caused by a syphilis infection. Moreover, treatment can be much more complicated among individuals diagnosed with secondary or tertiary syphilis. Getting treated for syphilis once does not prevent you from getting it again, so follow-up testing is recommended to ensure successful treatment.

What advice would you give to someone who may be concerned about the impact of syphilis on their sexual health? Any tips for talking to a provider about this topic given how taboo it can be?

Knowledge is power! Many people may be unaware that they have syphilis, and, as a result, do not seek out the treatment they need. As a longtime healthcare provider in our nation’s capital, I encourage my patients to get tested for STDs early and often.

Dr. Rashbaum, a nationally recognized authority on the care and treatment of persons living with HIV and AIDS, travels extensively lecturing on the management and treatment of HIV and other sexually transmitted diseases to both patients and fellow physicians. Dr. Rashbaum currently lives and practices medicine in Washington, D.C.

Additional Resources from HRC:

This post is not a substitute for sound medical advice — and the examples throughout it don’t cover every situation! We encourage you to seek out additional resources from other community advocates and, most importantly, talk to a knowledgeable healthcare provider before making any medical decisions.