Positive Life NSW

Syphilis and other sexually transmitted infections (STIs) have become increasingly common among HIV positive gay men. Syphilis in particular can have serious health implications for people with HIV, and looking after your sexual health is an important part of good HIV and health management. This fact sheet looks at some of the symptoms of syphilis. It also looks at some reasons why it is important for sexually active men with HIV, to test regularly for STIs, including syphilis.

Who is affected most?

Notifications of infectious syphilis have increased considerably in recent years. Anyone can get syphilis, but men who have sex with men account for over 90% of these recent infections in New South Wales. More than half of people diagnosed with syphilis are also living with HIV. So if you are HIV positive, sexually active, and having sex with men, it makes good sense to consider having regular tests for STIs, including syphilis.

What is syphilis? What are the symptoms?

Syphilis is an infection caused by bacteria. It can be difficult to know whether you have syphilis because it can present with a range of symptoms or none at all. A recent study of Sydney men with syphilis found that just over 70% of men experienced symptoms, while the remaining 30% didn’t notice any symptoms.1 In the early stages of the STI, symptoms may also be easily missed, and syphilis in people with HIV may present slightly different signs.

Signs or symptoms of syphilis can include a small painless sore in the area of infection (primary syphilis), and/or swollen lymph glands, rashes, fever, sore throat, muscle aches and tiredness (secondary syphilis). Some of these symptoms may be mild and can come and go, or they can even go away completely after a while. Because of symptoms like these, syphilis is often called ‘the great imitator’ in medical circles because it can be difficult to distinguish its symptoms from many other diseases.2

How is it transmitted?

Syphilis is highly infectious and is usually passed on during sex with an infected person. It can be easily transmitted through contact with syphilitic sores during unprotected anal, vaginal or oral sex. Condoms can reduce your risk of acquiring syphilis.
However, because it can be easily passed on by close physical contact with syphilitic rashes and lesions, which can be away from the genital area, condoms do not ensure complete protection.

How is syphilis prevented?

We know that using a condom significantly reduces the risk of getting syphilis.3 It’s true that condoms don’t offer complete protection, because potential transmission sites may not necessarily be just in the genital area. What’s more, syphilis (like some other STIs) can also be transmitted by oral sex. But the fact remains that condoms do make a big difference to syphilis transmission. In general, your chances of acquiring syphilis are much less likely with a condom than without. If you do choose not to use condoms with other positive guys, then the need for regular testing for syphilis and other STIs is crucially important.

What should I do if I think I may have been infected?

If you notice symptoms or think you may have been infected, you should have a test as soon as possible. It is important that you test without delay, if you notice any symptoms that might be syphilis, or you think you’ve been at risk. By doing this you will ensure syphilis won’t develop to a later stage and you won’t pass it on to anyone else. Symptoms may go away but this does not mean the infection has gone away. If you think there’s a good chance that you might have been infected, it’s important to avoid having sex until you’ve been tested and returned a negative result. If you return a positive result, you should stop having sex until your doctor gives you the all-clear following treatment.

How is it diagnosed?

Via a blood test specifically for syphilis. Most positive people have regular quarterly blood tests, but these don’t usually include a test for syphilis unless it’s specifically requested.

Regular testing is important

If you are sexually active, testing regularly for syphilis and other sexually transmitted infections is an important strategy to maintain your health and well being, and the health and well being of your partners. Many STIs, including syphilis, can be present with no symptoms, or with very mild symptoms. This makes regular and routine testing an even more sensible strategy for good health maintenance.

More sexual activity = more regular testing

Annual STI testing is recommended for people who are sexually active. If you have sex with a number of casual partners, or you have sex with someone else who does, you should have more regular STI tests (such as every three to six months).

Testing is easy

You can easily ask for a syphilis test when you get your CD4 count and viral load checked.

Am I tested for it anyway?

No. Recent research indicates that many HIV positive people believe that their HIV specialists routinely checked them for STIs as part of their usual blood tests for viral load and CD4 counts.4 You need to specifically ask for a test for STIs, including for syphilis.a test for STIs, including for syphilis.

Do HIV and syphilis on have an effect each other?

Syphilis may progress more rapidly in HIV positive people. As it progresses it can have very serious implications for your health. This makes regular testing even more important for people living with HIV. When you get an infection, your immune system needs to fight it off, and having syphilis can cause an increase in your viral load and can cause a decrease in your CD 4 count. Syphilis may also increase the likelihood of passing HIV on to an HIV negative partner.

How is it treated?

Syphilis is treated with a course of antibiotics – usually a series of injections in the buttock over 10 days. Yes that’s a pain, but if left untreated it can seriously damage your health.

What happens if it is left untreated?

Symptoms of syphilis may be unnoticed. If left untreated, syphilis can pass through three stages. Symptoms can develop within six weeks. These include:

1. Primary syphilis

At this stage, a hard painless sore, called a chancre, can appear in the area of infection. The syphilis chancre, which appears at the area of infection, will usually heal between ten and ninety days. However you will still have syphilis, even though symptoms might have gone.

2. Secondary syphilis

If left untreated, syphilis can develop into the secondary stage. This occurs between three to twelve weeks after the development of the chancre. People may experience a number of symptoms at this stage. These symptoms can include rashes on the hands and feet, fever, sore throat, muscle aches, swollen lymph glands and tiredness, or patchy hair loss.

3. Tertiary syphilis

Unless testing and treatment is sought, about a third of people will then progress to the third stage – tertiary syphilis. This will usually occur many years after the initial infection. At this stage the syphilis infection, while no longer contagious, can cause damage to your body, including the heart, brain and nervous system. This stage can eventually result in serious heart disease, blindness, mental illness and death. The damage caused in this late stage of syphilis cannot be reversed.

Latent syphilis

Syphilis without symptoms is called latent syphilis. This can occur at any time during untreated infection. During early infection, latent syphilis it is still infectious but not at later stages.

What if I have had another kind of STI recently?
If you have recently had an STI, like gonorrhoea or chlamydia for example, it would be a good idea to ask for a syphilis test as well.

Talk to your doctor

As with most aspects of HIV, it’s important to find a doctor you feel comfortable with. If you feel more comfortable, you can also go to a sexual health clinic. Sexual health clinics are free and you don’t have to use your real name. It can be a good idea, however, to inform your HIV doctor what kind of medications you are taking.

Some other STIs

Gonorrhoea

There have also been considerable increases in rates of gonorrhoea among gay men. It’s also caught via oral or anal sex or arse play. Gonorrhoea can be cured with antibiotics. Symptoms can include a discharge and/or pain when urinating, or a dry, sore throat or pain in the anus, but it is not uncommon to have no symptoms. Even if you don’t have symptoms an STI can still be passed on. Infection with an STI such as gonorrhoea can make you more likely to pass on HIV.

Chlamydia

Chlamydia is another STI which can infect the arse, dick or throat. While symptoms can also include a discharge or pain when urinating, it is not at all uncommon to experience no identifiable symptoms. Chlamydia is also easily cured with antibiotics.

LGV

Another STI (related to chlamydia) appears to be becoming more common. There have been reports of an outbreak of LGV (that’s lymphogranuloma venereum) among sexually active (mostly HIV positive) gay men in some countries (in Europe and North America). The majority of men had participated in unprotected anal sex and fisting in the twelve months before they reported symptoms. While symptoms may include, among other things, swollen glands, anal and genital sores or inflammation of the rectum and colon, it is also possible not to develop any symptoms. LGV can be cured with a course of antibiotics but if left untreated it can lead to serious health problems.

Once again, condoms are the most effective prevention method on offer but they’re only part of the package. It’s essential to be in control of your health, to have a clear understanding of how sexually transmitted infections are spread and to talk to your doctor about regular testing.

For more information on sexually transmitted infections, see the fact sheet: Sexually transmitted infections: a guide for people with HIV. This factsheet is available from Positive Life NSW.

Getting information and support:

• Sydney Sexual Health Centre. T (02) 9382 7440
• Albion Street Centre. T (02) 9332 9600 www.sesahs.nsw.gov.au/albionstcentre
• HIV/AIDS Information Line. T (02) 9332 4000
• Positive Life NSW. T (02) 9361 6011/1800 245 677 (freecall outside Sydney area) www.positivelife.org.au
• AIDS Council of New South Wales (ACON). T (02) 9206 2000/1800 063 060 (free call outside Sydney area) www.acon.org.au

Sources

1. Holt, M., Jin, F., Grulich, A., Murphy, D., Smith., G., Syphilis, STIs & men who have sex with men in Sydney, Understanding and managing risk, National Centre in HIV Social Research, monograph 7/2004
2. Holt, M., “The great imitator returns”, Talkabout, No. 138, April–May 2005
3. Holms, King K, Levine, Ruth, Weaver, Marcia, “Effectiveness of condoms in preventing sexually transmitted infections” Bulletin of the World Health Organisation, June 2004, 82 (6)
4. Holt, M., Jin, F., Grulich, A., Murphy, D., Smith., G., Syphilis, STIs & men who have sex with men in Sydney, Understanding and managing risk, National Centre in HIV Social Research, monograph 7/2004

Contact Positive Life NSW for other fact sheets in our series:

1. Managing side effects (efavirenz)
2. Boosting your energy
3. Getting started on combination therapy
4. I want to return to work
5. Living with body shape change
6. Positive Pregnancy
7. Clinical trials
8. A night with Tina (people with HIV who use meth)
9. HIV and your mouth
10. The dynamics of disclosure

Produced by the Health Promotion Unit of Positive Life NSW.

Copyright © 2005 Positive Life NSW. This information may be copied for personal or organisational use provided you acknowledge Positive Life NSW in the production of this fact sheet.

Funded by NSW Health.

This fact sheet was produced with the assistance of an unconditional grant from Gilead Sciences Pty Ltd.

This is only an extract of the text from this fact sheet; use the links at right to obtain the full content.