Syphilis: it's back!

An estimated 12 million people worldwide are infected by syphilis each year. Most (an estimated 90 per cent) are in the developing world. But since 2000, rates in developing countries have been on the up. WTF?

Syphilis infections were in decline in the developed world until the 1980s and 1990s, due to widespread use of antibiotics. But rates have been increasing in the US, UK, Australia and Europe – primarily among men who have sex with men.

In 2004, 1,956 cases were notified to the Department of Health’s Disease Surveillance System. Between 2004 and 2010 this figure increased by 25 per cent, and last year (2013), 3,461 cases were clocked up. Most are in urban or suburban areas, and in men – specifically, men who have sex with men.

Dr Kit Fairley has been the Director of the Melbourne Sexual Health Clinic since 2001. In that time, he’s seen the incidence of syphilis increase dramatically.

“In the past two decades, syphilis has increased all over the developed world. It was absent for about twenty years, then in the early 2000s we saw it come back with a vengeance,” he says.

“It took us a while to pick up on syphilis. What was probably happening was that firstly, doctors hadn’t seen it for 20 years and found it difficult to recognise. And secondly, we have a generation of gay men who had never seen or had to worry about syphilis before.”

A sexually transmitted infection (STI) caused by the Treponema pallidum bacteria, syphilis manifests in four progressive stages: primary, secondary, latent and late, or tertiary.

It’s been around since at least the fifteenth century, and while no one can quite agree where it came from, but it’s a dead cert that syphilis (“the great pox”) moves through four fetching stages. Painless sores and ulcers akin to an ingrown hair appear in the primary stage, and rashes, hair loss, fevers and general tiredness in the secondary stage. There are no symptoms in the stealthy latent stage, just detection by blood test. These stages of syphilis are all treatable; it’s the infamous tertiary or late stage that put paid to Napoleon, Oscar Wilde and Hitler, and is the one that will make you go slowly crazy then kill you. There are some wince-inducing, NSFW images of the various stages here, if you must.

Like its boner-killer cousins HPV (Human Papillo Virus, a.k.a. warts) and herpes, syphilis is passed from person to person by skin-to-skin contact. You can catch it through oral, vaginal or anal sex with a person who has primary or secondary syphilis; the secondary stage’s characteristic rash (back, hands, feet and chest alert) is particularly contagious. More rarely, it can be transmitted from mother to baby during pregnancy (congenital syphilis).

It’s tricky, says Dr Fairley, because it can be caught multiple times, and is very easy to catch – even when you’re practising sex that is safe, from an HIV perspective.

“Classically, syphilis is known as the great mimicker; the rash it gives is like any other rash from any other infection. But it’s very treatable, and once you’ve been treated, it’s gone. You don’t need ongoing treatment, as with HIV,” says the doc.

“Even if you’re using condoms for anal sex, it’s possible to catch syphilis through oral sex or even by masturbating someone, if the person you’re in contact with has a lesion.”

So do we have another sexual health epidemic on our hands?

No, says the doc, but there’s no doubt that syphilis is a serious STI.

“If you don’t treat it, it leads to substantial health consequences; problems with the heart and brain, hearing and eyesight. Here in Melbourne we’ve seen a few tertiary cases, where people are having trouble with their eyesight and hearing.”

Early recognition is key.

“If you’re a gay man having regular sex with different people, it’s important that you have regular checks, even if, from an HIV perspective, you’re practising safe sex. We recommend a full sexual health check up every six months.”

And there’s always room for improvement. Public health boffins have yet to implement a highly effective control program for syphilis.

“We need to work harder on early symptom recognition and testing, and make it easier for people to have regular testing,” says Dr Fairley.

“We’re working on programs to make it easier for gay men to be tested, like home testing, and testing in clubs. Every time you test for HIV, ask to be tested for syphilis as well; it doesn’t mean any extra needles.”

“We’re also pushing to change the legislation around blood tests, so that when you see a doctor you can have five or six tests from a single referral slip, without having to return to your doctor every time you want to get tested.”

Treatment is simple – one or perhaps a series of penicillin injections. This sure as hell beats the mercury and arsenic treatments that were the go until well into the nineteenth century, and would often kill a sufferer long before the syphilis itself. Modern medicine, FTW.

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