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Syphilis
What
is it?
Syphilis is an infection caused by a spirochete, a nasty little bacteria
that is shaped like a corkscrew, and is spread through skin-to-skin
contact. In Seattle/King County gay and bi men accounted for 95% of
syphilis cases in 2006, and 97% in 2007. Nearly 60% of those cases were
in guys who are HIV-positive, and a large percent were also meth users.
Most people got tested for syphilis because they noticed symptoms, but
as we talk about later syphilis can often be asymptomatic, meaning that
many people won’t even notice that they have it.
How
do you get it?
It's passed along by contact with the syphilis bacteria through a small,
sometimes almost invisible, painless sore, usually through unprotected
anal or oral sex with an infected person. Syphilis can be spread through
skin-to-skin contact when someone has a sore from syphilis.
How
do you avoid it?
By using condoms
for anal
and oral sex.
In addition, taking the time to discuss STDs
with your sex partners can be a way to get the information needed to
decide whether or not to steer clear of transmission via skin-to-skin
contact.
There are three stages to syphilis infection:
-
Primary Stage - occurs about 90 days (on average about 2-4 weeks) after initial exposure
a. Basically, you get a big red, painless sore called a chancre on your skin, usually at the site of infection
b. The chancre oozes a lot of bacteria-filled pus, which makes you highly contagious at this stage
c. Chancres can hide in your ass or mouth, and since they don't hurt you may never notice them - you can go through this entire stage without every knowing you are infected
d. Eventually, the chancre will heal over and go away - at this point the infection spreads to the rest of your body -
Secondary Stage - includes fever, fatigue, joint pain, swollen lymph nodes, eye and liver trouble, and a copper-color rash
a. The rash is usually found on the palms of your hands and the soles of your feet, but it can also be on your torso or other areas
b. The rash is still infectious, especially if it is "weeping," or pus is oozing from it
c. The rash and other symptoms will go away by themselves, but if left untreated the infection will lead to… -
Tertiary Syphilis - the symptoms for this stage can show up any time between 10-20 years after the initial infection (it will show up earlier in HIV positive men)
a. After the secondary stage you are no longer contagious
b. Syphilis attacks your brain - leading to insanity and dementia
c. Syphilis attacks your heart valves, particularly your aorta
d. If left untreated, tertiary syphilis can kill you
Testing
and treatment
If you think you might have syphilis, go to a doctor and find out for
sure. Only a person with a lot of letters after their name can diagnose
and treat your syphilis. Sometimes syphilis can hide in your ass and
mouth, which is why it is important to get the blood test as part of
your regular testing routine.
The good news is that syphilis is easy to treat. Just trot on down to your doctor's office and have him/her fill out the old Rx pad for a healthy dose of penicillin. If you're allergic, there's always doxycycline or tetracycline. But just because you get rid of your syphilis doesn't mean you can't catch it again.
It can be hard, but you should really notify any of your sex partners that you caught syphilis. Maybe one of them had it and didn't know. Maybe you've spread it to someone else. They will undoubtedly want to know about it. The best way to avoid spreading it or catching it is to use latex or polyurethane condoms with water or silicone-based lubes for anal sex (or even for oral, there are some tasty flavored condoms and lube out there nowadays). But even this won't keep you completely protected. Again, you can catch syphilis just by coming in contact with somebody's chancre sore or rash.
HIV
connection?
Syphilis is especially common in men with HIV,
and may be more serious in Positive
guys. Everyone with HIV should have a syphilis test, even if they
have no symptoms, and all who test positive and are treated should have
regular follow-up blood tests to ensure that treatment was effective.
If you have had neuro-syphilis, follow-up requires a spinal tap. Ouch!
A Chancre Short Story
Greg's alarm clock went off at 7 am, as it did every weekday morning. The loud beeping jolted him awake, and he sat upright, slightly disoriented. It took him a moment to realize what was happening - he rubbed his bleary eyes, and reached over to the nightstand to switch off the alarm. He slid his legs over the side of the bed, and his bare feet pressed onto the hard wood floors of his bedroom. He stood up, and stumbled sleepily into the bathroom.
The toilet seat was up, as it almost always was, and he aimed his semi-hard dick towards the bowl for his morning piss. That's when he noticed it. Looking down at his penis he saw a small bump that had never been there before. He thought perhaps it was a cut or bruise, except that it didn't hurt at all, even when he touched it. It was slightly reddish in color, or was that because he had been rubbing it?
Panic mode set in. "What the hell?" he thought. As a gay man his mind leaped to the immediate fear that he had got an STD. When was the last time he had sex? Was it last weekend? No, it was two weekends ago, when he and his friend Jeremy had gone to the baths. They normally fooled around with each other, a casual sort of fuck buddy friendship, but that weekend they were feeling a bit more adventurous and decided to try something new. It had been years since Greg had gone to the bathhouse, and Jeremy had never been before, so he thought he would show his friend around a bit.
They had got a room, cruised through the halls a bit, and found a guy that they both liked. The three of them went back to the room, and fucked around. The guy they had picked up fucked Jeremy (with a condom) while Greg fucked him. He used a condom most of the time, but had stuck his cock head in and out a few times at first, to get the guy loosened up, before slipping a rubber on to finish fucking. That's probably how it happened.
Greg was kicking himself. He was safe about 95% of the time, but occasionally had a lapse. He got tested on a regular basis, too, and outside of a case of gonorrhea about 3 years ago, everything always came back negative. He couldn't believe that he now had something. But what was it? Syphilis…? He heard it had been making a comeback in Seattle. Shit.
He got in the shower, and the warm water calmed him down a bit. When his mind stopped racing, he sorted out his thoughts and knew what he had to do. First things first, get to the clinic and make sure that it really is an STD after all. If it is, get it treated. He was cursing the nameless guy from the bathhouse. What a prick. How come he didn't say anything? Jeremy would need to know, too.
He called in sick to work. At Harborview, the clinician told him that the sore was a chancre, which is indeed caused by syphilis. Even though syphilis was typically detected through a blood test, she easily recognized the chancre for what it was. Greg learned that syphilis can be spread just from coming into contact with the infected area. And since chancres are usually painless, a lot of guys don't know that they've got them. Greg's anger at the bathhouse stranger subsided. If the guy had syphilis in his ass, he probably doesn't even know it. But Greg was kicking himself again. If only he had used a condom the entire time, this wouldn't even be an issue.
The clinician said that syphilis could be easily treated with an antibiotic, and she gave him a painful shot right in the ass. She also told him that it was good that he caught it early, in the primary stage. Secondary syphilis can cause much worse, flu-like symptoms (including headache, joint and muscle aching, fever, sore throat, swollen glands, and loss of appetite). In the third stage, which can happen anywhere from 5 to 35 years after infection, syphilis can attack the brain, spinal cord, heart or nervous system, which could be fatal. She also suggested he get tested for gonorrhea, chlamydia, and HIV as long as he was in. It had only been a month since his last test, but he figured what the hell.
After the throat culture, ass swab, peeing in a cup, and getting his blood drawn, Greg felt that he had been through the ringer. He called Jeremy to let him know what had happened. Greg tried to reassure him by telling him everything he had learned about syphilis at the clinic. Jeremy said he would make an appointment right away. Greg also said that Jeremy probably didn't have much to worry about since the guy had fucked him with a condom on the entire time.
"Yeah, but I blew him," said Jeremy. "Can’t it be passed orally?"
"Oh, shit, that's right," replied Greg. "It can. Yeah, you better get in soon. I guess that puts us out of action for a few days, huh?"
"Yeah, at least until the antibiotics do their thing," Jeremy responded. "Say Greg…?
"Yeah…?"
"What do you say we stick to only fucking with each other for awhile, huh?"
"Sure," Greg smiled. "I can try that."
Greg had always really liked Jeremy, even though he wasn't looking for anything too serious. He just wasn't the monogamous sort. But they had great sex, and were very compatible. And the idea of having safe sex with a person that he knew and trusted sounded like a good way to avoid any more of these scares. He also thought maybe he ought to go back to the bathhouse to see if he could find that guy and let him know what he had…