Syphilis is an infection caused by the bacteria Treponema pallidum. The bacteria are transmitted from person to person by close, intimate contact. Syphilis initially causes a sore on the skin where the bacteria multiply in large numbers. During skin-to-skin contact, like during sex, the bacteria are transferred from the sore to the skin of another person thus spreading the infection. Because these sores can develop wherever close skin-to-skin contact is made, condoms may not protect you. If a guy has a sore on the head or shaft of his penis, the condom will cover it. If, however, the sore is on his balls, lips, or mouth, condoms are not going to help. As a result, syphilis is easily spread by oral sex. In 2014 in Ontario, over 800 guys were diagnosed with syphilis.

Syphilis often fools people as it can cause a wide variety of symptoms, or cause no symptoms at all. Sometimes the symptoms are very mild and last only a few days and so are dismissed. Typically, syphilis progresses through several stages. That said, not everyone develops symptoms at each stage. When syphilis is transferred to the skin during intimate contact, the bacteria multiply and create an ulcer or sore on the skin. The ulcer is shallow, does not bleed, and is not painful. Sometimes it is small and hard to see, or, depending on the type of sex when it was transmitted, it may be tucked away somewhere less obvious like under the foreskin or at the back of the throat. Sores may develop days to weeks after contact and will eventually heal on their own. The sore is referred to as primary syphilis. While in the skin, the bacteria will multiply and eventually migrate from the skin ulcer into the bloodstream and thus spread throughout the body. This stage is called secondary syphilis and can have a variety of symptoms. The most common symptom of secondary syphilis is a rash. The rash may be everywhere or on only some parts of the body, and may or may not appear on the palms of the hands and soles of the feet. People with secondary syphilis may also have fevers and muscle aches, like the flu. Because syphilis at this stage is spread through the bloodstream, it can infect any organ. For example, the bacteria can get into the eye and cause blurry vision, infect the liver and cause hepatitis, or enter the brain and cause meningitis. If untreated, the secondary symptoms will eventually go away on their own and the bacteria will become less active. This period of low activity is called latent syphilis and lasts for years. At this latent stage, people have no symptoms. Over time though, the bacteria can continue to cause harm. Years after infection, syphilis can damage the heart, the spinal cord making it difficult to walk, and the brain causing dementia much like Alzheimer’s.

Syphilis is diagnosed by recognizing the symptoms, and by a blood test. In Ontario, the blood test has 3 parts: the screening test, called the CLIA, and the confirmatory test called the TP-PA. When you get syphilis, these blood tests become positive and will remain positive even after treatment. The third test is called the RPR and is reported as a number such as 1:2 or 1:64. This number reflects how active the infection is. After treatment, as the bacteria die the RPR number will fall and after many months the RPR may eventually become negative. If you get syphilis again, the RPR number will rise again.

In the early primary and secondary stages, syphilis is treated with a one-time injection of penicillin. The penicillin used is a particular formulation that remains in the blood for a week. As an alternative, early syphilis can also be treated with doxycycline, one pill twice a day for 2 weeks. If you are diagnosed with latent syphilis, you will receive an injection of penicillin once a week for 3 weeks, or take oral doxycycline for 4 weeks. Finally, if syphilis has infected the brain or spinal cord, high dose intravenous penicillin is required. After treatment, you must go for blood tests every 6 months to be sure the RPR number declines. This is to be sure the treatment worked.

Because it is so easily transmitted, syphilis can be a challenge to prevent. Condoms help, but are not a sure bet. Since you can have syphilis and have no symptoms, it is a good idea to get tested periodically. If you are diagnosed with syphilis, make sure your sexual partners are also tested and treated. One thing you don’t want to do is to swap syphilis back and forth.