So, it has been awhile since I have talked about one of the fastest spreading infections in Utah: syphilis.
Interestingly, syphilis was once thought to be eradicated. It had its time back in the 1930s and 1940s and was so noteworthy that it generated one of the first public health interventions at the hands of the U.S. Public Health Services. Syphilis cases were so endemic in many communities in the United States that at one point in the ’40s, an estimated on- in-four black men in the South were infected. Syphilis was also behind one of the worst moments in the history of U.S. public health services: the Tuskeegee syphilis experiments, in which health workers withheld penicillin (which can cure syphilis) from black people with the disease who were participating in a study.
Syphilis is an infectious disease that drives fear in many clinicians. It is a bacterial infection that is very infectious in its early stages and is transmitted through sexual contact, which includes any intimate, skin-to-skin contact (even oral sex!). The bacteria can penetrate intact skin and tries to work its way into the central nervous system, where it can cause neurological damage or sudden death. It has long been referred to as the “great imitator,” as its symptoms are somewhat generic or often mimic those of a long list of other diseases. Many physicians and medical providers were not trained to diagnose syphilis because it was so rare. As a result, many cases are either misdiagnosed or undiagnosed.
Why is all of this important? Well, currently, we’re in what can be considered a syphilis epidemic here in Salt Lake County. The majority of cases — if not all recent cases — are among men who have sex with men. Worse, well over50 percent of the diagnosed cases are within the HIV-positive community — which means the epidemic has permeated many networks of HIV-positive men who are having unprotected sex. As a result, many people getting syphilis are also being infected with HIV. Dual infection with HIV and syphilis can be very serious and can allow cases to rapidly progress to neurological disease.
Symptoms of early stage syphilis often present as sores or lesions, usually at the part of your body where you were exposed to it. These sores are not painful, so if they appear in an area that is not visible, such as the rectum or inside the shaft of the penis, many patients have no idea that they are there. Many patients will present with sores in their mouth after engaging in oral sex; these are often dismissed as cold sores. Other symptoms include any unusual skin issues, such as a rash or bumps, or patchy hair loss. Some patients will experience lymph node swelling in the groin area, others will experience significant flu-like symptoms. Many patients do not show or develop any symptoms, and symptoms will go away usually within a few weeks with or without treatment.
Treatment usually involves between one to three shots of penicillin, which is often provided for free at the local health department. It is also critical that all sexual partners be tested and treated, as it is very easy to be re-infected after treatment. If re-infection occurs, it may easily go undiagnosed for reasons I’ve mentioned. Testing involves a simple blood test, and results usually take about a week to be returned.
This epidemic isn’t just here, though. It appears to be occurring throughout the entire country and in other countries. The Prague Monitor recently reported an increase in syphilis cases in the Czech Republic, the majority of which were also occurring in gay men. Like here, many cases in other areas of the country are occurring within the HIV-positive community, and are driving many new HIV infections.
Due to the epidemic, the Salt Lake County Health Department is recommending routine screening twice a year for all MSM. In the meantime, there’s a lot you can do to protect yourself from syphilis and from other sexually-transmitted diseases. Condoms are certainly an effective barrier (and remember it can be transmitted during oral sex.). As always, don’t rely on just “knowing “ your partners as a prevention method. There’s a really good chance that your partners have no idea that they are infected and are spreading a disease to you.
If you would like to know more about syphilis, including low-cost testing, please contact the Salt Lake Valley Health Department at 801-534-4601.