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Syphilis: Everything you need to know about the STI ‘everyone seems to forget’

Colorized electron micrograph of Treponema pallidum, the bacteria that cause syphilis
Colorized electron micrograph of Treponema pallidum, the bacteria that cause syphilis (Image: Unsplash/National Institute of Allergy and Infectious Diseases)

Whenever I talk about STIs with my (non-medical) friends, the discussion mainly centres around the ‘unholy trinity’: chlamydia, gonorrhoea, and HIV. That’s understandable as we’ve made so much progress in detecting, treating, or preventing these conditions.

However, there’s one STI that everyone seems to forget: syphilis. Cases are on the rise across the world and increased use of PrEP and reduced reliance on condoms have inevitably contributed to this. If left untreated, it can lead to life-threatening consequences.

Here’s a reminder of everything you need to know.

Syphilis is caused by bacteria that can be transmitted through oral, vaginal, and anal sex. The infection presents itself in three stages:

Primary syphilis: The first signs can show up anywhere between 10 days to three months after infection. Usually, it manifests as a painless but highly infectious sore (chancre). These tend to heal in a few weeks, but the infection remains in your body if you don’t have treatment. The lymph glands in the neck, armpit and groin may swell too.

Secondary syphilis: If the infection isn’t treated in the first stage, various symptoms will manifest themselves: a blotchy rash on the body; hair loss; white patches inside the mouth. Growths like genital warts can start to appear too.

Tertiary syphilis: The infection eventually progresses and damages the heart, brain, bones and nervous system. It could give you serious problems like blindness, dementia, or even a stroke. It can result in irreversible damage even if treated.

“Untreated syphilis will not go away on its own and could lead to serious problems or even death”

Syphilis is usually passed on through contact with a chancre in the first stage or the rash in the second stage (especially during intercourse). Sharing sex toys can also spread it. Getting tested and treated is easy. A simple physical examination, blood test, and swab of any sores will usually give the diagnosis, and it can be cured with a short course of antibiotics (either given by injection or by mouth).

Although there is a call for antibiotics like doxycycline to be incorporated into PEP and PrEP prescriptions to try to reduce infections, this has not become standard practice yet. Untreated syphilis will not go away on its own and could lead to serious problems or even death. Don’t be fooled. Be alert to the symptoms, get checked regularly, and get treated as soon as you can.

This feature first appeared in Attitude issue 356, available now.

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