Tuan from Sydney writes: A sexual partner has tested positive for syphilis. I’ve no symptoms — what should I do?
Dr Louise replies: Thanks for your question, Tuan. First a few facts about syphilis: syphilis is a sexually transmitted infection (STI) caused by the Treponema pallidum bacteria. Syphilis is transmitted by close skin-to-skin contact. This includes oral, vaginal and anal sex, and close contact with someone in the early stages of syphilis. If not diagnosed and treated appropriately, it can have serious outcomes.
There are various stages of infection. The first stage, ‘chancre’, is usually a painless ulcer or sore that appears at the site of infection. So the site of contact determines where the sores will appear e.g. on the penis; in the anus or perianal region; on the lip; in the throat; even the fingers. This may go unnoticed and the syphilis will progress to the secondary phase.
Phase two may include skin rash, which may show on the trunk, hands and feet. Fatigue, swollen glands and general tiredness may also present at this stage. Many other conditions mimic syphilis symptoms, so it’s about being alert to the possibility and getting screened. Remember, even if you’re using condoms for anal sex, syphilis can still be transmitted via oral sex or close contact — so it’s important to test regularly.
The gold standard test is a blood test. It can take a few months after infection to become positive, so if there is an ongoing risk of infection then it’s best to have this test two or three times a year. There is an online tool — check your risk — that assesses your sexual risks (anonymously) and makes suggestions for the types of tests you should have.
Syphilis is easily cured with penicillin — ideally an injection. The length of treatment depends at what stage the syphilis is at. You should wait at least a week after treatment before having sex. Testing and treating sexual contacts is really important, so get them to see their doctor or use the let them know website to assist with contact tracing.
The problem with undiagnosed syphilis, aside from the risk of transmission to others, is, in people living with HIV, it can behave in unusal ways and serious side effects may present earlier than in the regular population. Untreated syphilis may cause neurological damage or liver function abnormalities. So if you are seeing a number of sexual partners, the bottom line is: get screened regularly for STIs. That means urine, throat and anal swabs for chlamydia and gonorrhea; and a blood test for syphilis — even if you show no symptoms.