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Syphilis and Men Who Have Sex With Men

What Is Syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator," because so many of the signs and symptoms of syphilis are indistinguishable from those of other diseases.

How Is Syphilis Spread?

The syphilis bacterium is passed from person to person through direct contact with a syphilis sore (also called a chancre). Sores occur mainly on the external genitals, in the vagina, on the anus, and in the rectum. Sores also can occur on the lips and in the mouth (areas covered by mucous membranes). Transmission of the bacterium occurs during vaginal, anal, or oral sex. Persons with either primary or secondary syphilis (in the early stages) can transmit the disease. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through casual contact, such as with toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Why Should Men Who Have Sex With Men Think About Syphilis?

Over the past several years, increases in syphilis among men who have sex with other men have been reported. In the recent outbreaks, 20% to 70% of cases occurred in men who also have HIV. While the health problems caused by syphilis in adults are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. In fact, there is a two- to five-fold increased risk of acquiring HIV infection when syphilis is present.


Syphilis Symptoms

Primary Stage

The primary stage of syphilis is usually marked by the appearance of a single sore, but there may be multiple sores. The duration between infection with syphilis and the onset of the first symptoms can range from 10-90 days (average 21 days). The sore is usually firm, round, small, and painless. It appears at the spot where the syphilis bacterium entered the body. The sore generally lasts three to six weeks, and it heals with or without treatment. However, if adequate treatment is not administered, the infection can progress to secondary syphilis. 

Secondary Stage

The secondary stage of syphilis is characterized by a skin rash and mucous membrane sores. This stage typically starts with the development of a rash on one or more areas of the body -- the rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the initial sore is healing or several weeks after it has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish-brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection may progress to the latent and late stages of disease. 

Late Stage

The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the infection remains in the body. In the late stages of syphilis, the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints may subsequently be damaged. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

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