STD 101: Syphilis

Following up on my recent post on addressing the social stigma of HIV/AIDS, I would like to talk about syphilis - one of the lesser evils in the family of sexually transmitted diseases (STI). This, after coming along with a friend to a clinic to get a second dose injection for its treatment by which I was informed rather painful. 

Before I even begin to talk about syphilis, I'd like to emphasize on the awareness of STI in general, and how we should all play a part in dissolving the social stigma concerning STI. 

1. Wherever you go, you should not be judged by your sexual behaviour.
2. Give advice willingly, and you owe it to yourself to be informed.
3. Ask as many questions as you need to - do not assume. And make sure you get answers that you understand.

What is syphilis and what causes it?

Syphilis is an infectious disease classified under sexually transmitted disease. It is caused by a germ called Treponema pallidum. While the symptoms of a syphilis is difficult to diagnose, untreated for a long time it can cause complications to the brain, the cardiovascular system and even death. 

Syphilis can infect both men and women, and they both can pass it on. An interesting fact about syphilis is that it is known with another name: The Great Imitator. This, because it has so many symptoms, many of which look like symptoms for other diseases. (This was how I was told by this friend of mine: "I have the great imitator." I didn't know anything about syphilis back then so I just gave him a blank stare!)

Speaking of passing it on, how is it spread?

As mentioned earlier, syphilis is a sexually transmitted disease, therefore any man or women who leads an active sexual lifestyle is at risk. However, sex is not the only way syphilis is passed on. 

• It can be passed on unknowingly from the infected person as the symptoms are difficult to differentiate from other disease. An infected person may not know he/she is infected for years and continue to live a healthy life.
• Direct skin contact with the syphilis sore or syphilis rash can lead to infection. 
• Direct blood transfusion can also pass on the germ that causes syphilis. 
• It is also possible for a pregnant mother to pass on the disease to her unborn baby. 

You cannot catch syphilis from kissing, hugging, sharing baths or towels, swimming pools, toilet seats or from sharing cups, plates or cutlery. Just as the HIV virus, saliva and urine do contain the germ that causes syphilis, but not in enough number for it to become an infecting agent. 

What are the signs and symptoms?

As aforementioned, it is difficult to diagnose syphilis from symptom alone. My friend found out by chance doing an annual medical checkup in a specialist hospital. I was later informed - and this is important information - that there is no exact way to test how long has the infection been there. 

However, syphilis can develop in three stages:

1. the first stage: called primary syphilis
2. the second stage: called secondary syphilis
3. the third or latent stage: called tertiary syphilis.

Primary Syphilis

This is the earliest stage and generally occurs from 10 days to 3 months after infection. It typically causes a painless ulcer on the genitals.

Secondary Syphilis

This is the second stage of syphilis. Many different symptoms can occur (see later) but usually last several weeks. They can, however, come and go for up to two years.

Tertiary Syphilis

This is the final stage of syphilis. Untreated after many years, it may start to cause very serious damage to the heart, brain, eyes, other internal organs, bones and nervous system.

Arguably, there is another stage between secondary and tertiary syphilis called latent syphilis. Latent means 'hidden'. This occurs after the symptoms of secondary syphilis have cleared. With latent syphilis there are no symptoms. Latent syphilis can last for many many years. It is divided into two types:

• Early latent syphilis: This lasts for a year or so and the infected persons are still infectious - that is, they can pass syphilis on to other people.
• Late latent syphilis: About two years after secondary syphilis has cleared the infected person can become non-infectious and are no longer able to pass syphilis on to others.

If the symptoms are difficult to diagnose, then how will I know if I am infected?

The only way to be certain is to be tested for syphilis. Most government hospitals and clinics do run these tests, and - get this - they don't mind running the tests for you even if you look and feel healthy as a bell! So go ahead, if:

• you, or a partner, think you might have symptoms
• you have recently had unprotected sex with a new partner
• you, or a partner, have had unprotected sex with other partners
• a sexual partner tells you they have a sexually transmitted infection
• you have another sexually transmitted infection
• you are pregnant or planning a pregnancy

go get tested. 

What happens during the test?

• The doctor or nurse will ask you to give a blood sample. 
• They will do a genital examination. 
• For women this may include an internal examination of the vagina and; 
• For men an examination of the penis, foreskin and urethral opening (where urine comes out). 
• Both men and women may have the anus examined internally and externally. 
• The doctor or nurse will also check the body generally for any rashes or warty growths. They may check the mouth and throat area. 
• They will use a swab to collect a sample of fluid from any sores. 

This only takes a few seconds and is not painful, though it may be uncomfortable for a moment. 

If I have syphilis, how will I be treated?

Just like another human being, generally speaking. Medically though, because syphilis is a germ infection, it can be readily treated with antibiotics. Antibiotic injections are the usual treatment. Benzylpenicillin is the antibiotic usually used. This kills the germs (bacteria) and prevents the disease from progressing any further. The injections are given intramuscularly (IM), usually into the buttock (this may explain why my friend adamantly asked me to drive >.<) . A single dose can be given for primary and secondary syphilis. Later stages may need a course of three injections, at weekly intervals. Neurosyphilis usually requires more frequent, daily doses for a couple of weeks.

What if I am allergic to penicillin?

Well, you're screwed. Or rather, mother nature screwed you. I'm kidding, of course. Other antibiotics are sometimes used if you are allergic to penicillin. Azithromycin is often used in this situation.

What if I am pregnant?

Well your husband must've screwed you up well, didn't he? OMG hahaha! I'm kidding again. If syphilis is found during your pregnancy, you can be given treatment safely. This can help prevent the baby from becoming infected and there is no risk of the treatment harming the baby. If the syphilis is untreated you may pass the infection to your baby in the uterus. This can lead to miscarriage or stillbirth, or the baby being born with syphilis.

Wrap up

Something to keep in mind if you have an active sexual lifestyle, especially with multiple partners, do keep safe. Abstinence from sex is the surest way to not contract any STIs, however in cases where sex just cannot be avoided use protections, and use them correctly. 

If you are diagnosed with syphilis or any other STIs, don't fret. It's not the end of the world yet. You just have to live it a little differently. And I'd like to keep thinking that the possibilities of sex is not completely and entirely shut - just take it to inform your engaging partner of your condition, and only go forth with mutual consent. Again, abstinence from sex is probably the best, but in situations where sex just can't be avoided and must be done, do use protection and use them correctly. 

Another note to be highlighted is that just because you were once cured of syphilis does not mean you cannot catch it again. Be safe, use protection. On a final note, I want to adopt a new slogan for anyone living with STD:

You're not sick, you just have a condition. 

Until next time, ciao!