SYPHISTORY | SmartSex Resource


A little syphilis history

Syphilis is a sexually transmitted infection (STI) caused by the bacterium, Treponema pallidum. Syphilis has a long history - the earliest outbreak was recorded in 1494! Syphilis raged across Europe and South America during the 16th century. And during World War I, syphilis was the 2nd most common reason for soldiers missing duty.

Famous people throughout history have had syphilis, from Beethoven, Henry VIII and the writer Leo Tolstoy, to Al Capone, Abe Lincoln and Vincent Van Gogh. At the turn of the 20th century, it was estimated that up to 1 in 10 men in Western countries had syphilis. But the use of penicillin as a cure in the 1940’s started to win the war against syphilis. As recently as 1999, there were only a handful of cases reported and we thought syphilis could be eliminated in Canada.


So what’s the big deal?

Think you don’t have to worry about syphilis anymore? Think again. Since 2000, syphilis rates have surged worldwide. In 2015 and 2016, BC saw the highest rates of syphilis in over 30 years.

In BC, most syphilis infections are in gay, queer, bisexual and other men who have sex with men (cis and trans). The highest infection rates are among younger men (20-39 years). And about half of all infections are in gay men who are also living with HIV. Syphilis and HIV do not play well together – not only can syphilis increase your chances of getting or passing HIV, but HIV can also increase the risk of complications due to syphilis.


Infectious Syphilis in BC and Canada

How do you get syphilis?

Syphilis is very infectious. If you have syphilis in its earlier stages, the chance of passing it to a partner is about 30%.

Syphilis is passed through direct contact with a syphilis sore during penetrative sex or oral sex. People who are pregnant and get syphilis can also pass it to their baby.

While wearing a condom is always recommended, sometime syphilis sores occur on areas that aren’t covered by a condom. So it’s still possible to get syphilis even if you are using a condom.

If you get syphilis once, it does not protect you against getting syphilis again. People can get syphilis multiple times in their life, even if they are treated with medication each time.


What does syphilis look like?

Syphilis goes through several different stages. While the stages have different symptoms, syphilis may not cause noticeable symptoms or even any symptoms at all.

Primary syphilis: The main symptom is a painless sore, called a “chancre”. It usually takes 3 weeks after infection for the sore to develop, but it can take up to 3 months. The chancre can show up on the penis, anus, vagina (frontal hole) or other parts of the body. You may not even notice it. This stage is very infectious.

Secondary syphilis: Symptoms can include a rash on the body (often on the palms and soles of feet), patchy hair loss, fever, enlarged lymph nodes (“swollen glands”) or a general feeling of being unwell. These symptoms usually show up 2 to 12 weeks after the chancre appears, but can take up to 6 months. You may not notice these symptoms either. There is also the chance at this stage for syphilis to infect major organs (e.g. liver, brain, kidneys). This stage is very infectious.

Latent syphilis: This is a hidden stage, where the person is infected with syphilis but doesn’t have any symptoms. Syphilis can still be passed on to other people during this stage.

Tertiary syphilis: This is the stage in which syphilis has infected major organs, like the heart or brain. It can cause permanent damage and very serious complications. For example, in the heart, syphilis can damage the aorta and heart valves. In the brain (known as neurosyphilis), it can cause many symptoms, from headaches and dizziness to dementia and changes in personality. It can also infect the nerves, causing blindness, deafness or paralysis.

While tertiary syphilis usually takes years to develop, syphilis can sometimes affect major organs early on. Neurosyphilis can occur at any stage of syphilis infection. People living with HIV who have been infected with syphilis are at higher risk of developing neurosyphilis than those who are HIV-negative.

2/3 of people with syphilis do not have symptoms


Testing and treatment

The only way to know if you have syphilis is to get tested.

Syphilis testing is usually done with a blood test. However, it may take up to 3 months before syphilis can be detected by the blood test. So, if you think you have been exposed to syphilis in the last 3 months, you need to get tested and treated.

Syphilis is curable. The best treatment for syphilis is a penicillin injection. Depending on the stage of infection, it can take up to 3 injections of penicillin to cure syphilis. Intravenous penicillin for 10 to 14 days is needed to cure neurosyphilis.

If you are allergic to penicillin, another antibiotic (doxycycline) can be used to cure syphilis.


Syphilis is cureable


Protecting your partners

Using condoms can help prevent syphilis, but it’s still possible to pass it even with a condom if the sore or lesion is outside the area the condom covers.

Another good way to protect your partner is to regularly test for syphilis. We recommend sexually active gay or bisexual men (both cis and trans) get tested every 3 months. Because syphilis may not have symptoms, getting tested is the only way to know if you have it.

If you get syphilis, it is important to let your sex partners know so they can be tested and treated for syphilis too. Because it is so contagious, syphilis can spread very quickly within the community. Making sure your partners get tested and treated as soon as possible will help stop syphilis from spreading.

The period of time when partners are at risk for syphilis depends on the stage of syphilis. This is known as the “trace-back” period. The trace-back period is 3 months for primary syphilis, 6 months for secondary syphilis, and 12 months for early latent syphilis. Anyone you had sex with during the trace-back period is at risk of getting syphilis and should be tested. Anyone you had sex with in the last 3 months should also get treated, because it can take up to 3 months for a blood test to become positive.


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