
New data from UKHSA that reveals a sharp rise in syphilis infections nationwide, and here in the West Midlands in particular, reminds us that syphilis has not gone away – and we must work harder to prevent it, diagnose it, and treat it.
There are usually three stages of syphilis. The first, known as primary syphilis, often presents as a painless ulcer (or “chancre”). This could be in the mouth, vagina or around the anus. This is something called a “primary” chancre. Because so many of us are unaware that syphilis is a potential problem, these are easily missed. They usually start to show up around 21 days (3 weeks) after you’ve been infected. However, they can show up anywhere from 10 days to 3 months after you’ve been infected.
✔ Symptoms of primary syphilis: a painless ulcer in the mouth, vagina, or anus.
If primary syphilis is not treated, what follows is secondary syphilis. This can occur between 6 weeks to 6 months from the time of infection. You may get a rash while the first chancre heals or a few weeks after it heals. The rash caused by syphilis: it is often is not itchy. It can look rough, red or reddish-brown. Sometimes it is so faint that it’s hard to see.
The rash often starts on the trunk of the body. That includes the chest, stomach area, pelvis and back. In time, it could also appear on the limbs, the palms of the hands and the soles of the feet. These last two are telling signs: there are not many conditions that cause a rash on the palms and soles of the feet!
Along with the rash, you may have symptoms such as wart-like sores in the mouth or genital area, hair loss, muscle aches and Fever. You can also sometimes get a sore throat and swollen lymph nodes, as well as tiredness and fatigue.
✔ Symptoms of secondary syphilis: a rash on the chest, stomach, pelvis or back; later, the limbs, palms of the hand and feet. Wart-like sores in the mouth or genital area; hair loss, muscle aches, fever. Sore throat, swollen lymph nodes.
The trouble is people may mistake these symptoms as the ‘flu, or more recently COVID-19. It’s important to remember that primary or early HIV can also present like this.
The symptoms of secondary syphilis may go away on their own. But without treatment, they could come and go for months or years.
People are particularly infectious to their sexual partners in this secondary phase, which is why syphilis can spread so readily if not diagnosed and treated.
If you aren’t treated for primary or secondary syphilis, the infection moves from the secondary stage to the latent stage. This also is called the hidden stage because you have no symptoms. The latent stage can last for years. Your symptoms may never come back. But without treatment, the disease might lead to major health problems or complications.
After the latent stage, up to 30% to 40% of people with syphilis who don’t get treatment have complications known as tertiary syphilis. Another name for this is late syphilis. At this time, the infection may damage the:
✔ Brain.
✔ Nerves.
✔ Eyes.
✔ Heart.
✔ Blood vessels.
✔ Liver.
✔ Bones and joints.
These problems may occur many years after the original, untreated infection.
So what can you do? Testing, testing, testing is the answer. The best place to get this done is at a sexual health clinic.
Everyone who attends a seuxla health clinic should be offered a test for HIV, Syphilis and hopefully Hepatitis B and possibly Hepatitis C, as all can be sexually transmitted and have very long asymptomatic periods.
Condom use will also give people some protection, but few people use condoms for oral sex. We are definitely seeing more people acquiring or catching syphilis through oral sex.
Have you had sex abroad on holiday? Think about testing when you get back.
Syphilis has definitely not gone away and it’s spreading in both the heterosexual and GBMSM community as shown in the latest Stats from the West Midlands.
If you have any of the symptoms described above, I would certainly recommend getting tested. If we do diagnose syphilis, early treatment is pretty straightforwards although a bit uncomfortable. It consists of 2 injections of penicillin, one in each buttock – this may be needed only once in early syphilis or for 3 weeks for latent syphilis.
Treatment needs to be undertaken in a specialised clinic. Don’t forget: it’s really important to get your sexual partners tested. Health advisors in the Sexual health clinic can help you with this anonymously.