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Infectious syphilis diagnoses are at their largest annual number since 1948 in England, with cases increasing by 15.2 per cent from 2021 (7,543 cases) to 2022 (8,692 cases). Despite sexually transmitted infections (STIs) usually being easily treated with antibiotics, they can cause serious health issues if left untreated – which, in the case of syphilis, can result in serious, irreversible and potentially life-threatening problems with your brain, heart, or nerves. To understand more about what syphilis is, how to spot it and what kind of treatments are available, GAY TIMES worked with Sam, a doctor at the Dean Street Express and 56 Dean Street sexual health clinics in London, to answer the most commonly asked questions he gets asked about it. 

What is syphilis?

Syphilis is a bacterial infection caused by an organism called Treponema pallidum. Despite popular belief, it is not an uncommon STI and rates of it are rapidly increasing, as figures from the UK Health Security Agency (UKHSA) show. It can be transmitted through sexual intercourse, as well as passed on from parent to baby if there is an active infection during pregnancy. 

What are the signs and symptoms of syphilis? 

It’s important to note that syphilis can have a wide range of symptoms and is nicknamed ‘The Great Pretender’ because of the way it often mimics other conditions and diseases. However, there are some common signs to look out for, which include: 

  • Ulcers and/or sores on the genitals that are known as a chancre and are often painless;
  • Rash that spreads across the body;
  • Tiredness and exhaustion and/or generally feeling unwell.

Some patients can also develop what is known as ‘neurosyphilis’, which occurs when the bacteria gets into the fluid surrounding the brain and affects the nerves. It usually presents itself in the form of new headaches and changes in your ability to see and/or hear. It’s important to share all your symptoms with clinicians as neurosyphilis is treated differently to syphilis.

Many patients don’t report any signs or symptoms when diagnosed with syphilis and it is often picked up during routine sexual health screenings, making regular testing all the more essential.  

How do you get tested for syphilis?

There are a number of tests for syphilis, but the most common are blood tests or a swab taken from an ulcer. 

If you have been tested in the past, you may have noticed that you are asked if you have had syphilis before – this is so clinicians know what type of blood test needs to be sent off. If you have never knowingly had syphilis before, clinicians will perform a blood test looking for antibodies. If they are present, it’s likely you’ve previously been infected and further tests would be run and treatment arranged. 

If you have been treated for syphilis before, clinicians won’t look for antibodies and will instead run a different test which takes a little longer and looks for a new infection. It’s really helpful to keep track of your history with syphilis as it will assist clinicians in understanding how long it has been since you caught the infection.

It’s important to remember that syphilis can take up to three months to show up on tests after you catch it, so keep testing even during periods where you may be having less sex.

Is it true that once you’ve had syphilis it never leaves your body?

This is a very common misconception about syphilis, as once the infection has been fully treated the only thing that remains are antibodies. However, these just show that your immune system has encountered syphilis before in the same way it has other infections, such as chickenpox. These antibodies do not offer you any protection from a future infection of syphilis, meaning you can be reinfected if you come into contact with it again.

How is syphilis treated?

In the majority of cases, syphilis is very easy to treat and usually involves either a one-off dose of penicillin given by injection into the upper part of each buttock or, depending on allergies, a couple of weeks of tablets. Sometimes, there may be a need to take a longer course of treatment if it’s not possible to confirm whether or not the syphilis was contracted in the last two years. This is because it will then become what is known as a ‘late’ infection, once again showing that regular testing is the best way to catch things as early as possible. 

The main side effects patients report is some tenderness around the injection site, however the medication is mixed with anaesthetic to reduce any potential discomfort. Some people also experience a flu-like illness after treatment, which is caused by the syphilis breaking down in your body and should only last a few days. Seek medical advice if you have any concerns when it comes to side effects. 

After treatment has been given, it can take up to two weeks to be fully clear of the infection and as such clinicians ask that you refrain from having any sex – including oral – during this period.

To learn more about syphilis, click here