Frequently Asked Questions About Syphilis

What is Syphilis?
Syphilis is primarily a sexually transmitted infection (STI) caused by a bacteria called Treponema Pallidum.

Should I be Worried about Syphilis?
You may be tempted to think that syphilis isn't a concern in Canada. And in fact, a few years ago that may have been the case. Since the early 1980s the rate of syphilis had been declining to the point in 1997 where syphilis was on the brink of elimination. However, since that time, the rate of syphilis in Canada has been steadily increasing in both males and females. The rate in 2001 is believed to be more than double that of 1997.

Syphilis can be a very serious infection (see Symptoms below) and that alone is reason enough to be concerned over the increasing rates. But - the interaction between syphilis and HIV - makes the increasing rates of this infection even more troubling.

Having syphilis can actually increase your chances of acquiring an HIV infection - by three to five times. And if you are HIV-positive, also having syphilis can increase the risk of transmitting the virus to someone else. Syphilis can also progress more quickly and be more difficult to treat in people who are HIV-positive.

How is Syphilis Transmitted?
Syphilis can be transmitted through oral, genital or anal sex with someone with an active infection. Although less common, it can also be transmitted through injection drug use, through broken skin on the body and from mother to child during pregnancy.

Syphilis is infectious, or able to be passed from one person to another in the first year to two years after infection. After two years, it goes into a dormant or non-infectious state and is no longer able to be transmitted, but can cause serious damage to the body tissues and organs.

Prevention and control of syphilis is the same as for many other STIs - using condoms for all sexual activities including oral sex, reducing the number of sexual partners, avoiding sharing of injection equipment, screening high risk populations and treating infected individuals and ensuring that their partners are notified, tested and treated. Testing early in pregnancy is also important to prevent congenital syphilis in infants.

What are the Symptoms of Syphilis?
It is important to note that not everyone with syphilis develops symptoms.

Syphilis has been called the “great imitator” because of the wide range of symptoms that infected individuals can have. These symptoms may be confused with other conditions or diseases and can be overlooked by a healthcare professional as the rate of infectious syphilis in Canada has traditionally been low.

Primary syphilis is characterized by a painless open sore called a chancre (pronounced shan-ker). It can appear anywhere from weeks to a couple of months after infection at the site where the bacteria entered the body. This means the chancre could be found in the genital area, throat or anus. Because it is painless, an infected person may not realize they have a chancre and their syphilis infection can quite easily go undetected. Although the chancre will usually go away on its own without treatment, it does not mean that the syphilis infection is gone. The infection progresses to secondary syphilis where a person may have patchy hair loss, a rash on the soles of the feet or palms of the hands or elsewhere on the body, fever, swollen glands and muscle and joint pain. These symptoms also usually disappear without treatment.

After around two years, syphilis goes into a latent or dormant state. It may progress to tertiary syphilis and affect the brain, the blood vessels, the heart or the bones.

How is Syphilis Diagnosed?
Your healthcare provider may suspect you have syphilis based on your medical and sexual history and physical examination. Syphilis is often diagnosed through a blood test and there are different blood tests available. Sometimes a sample can be taken from the chancre itself, if present, and the sample can be examined under a microscope. In other cases, a small amount of fluid from around the brain and spinal cord can be taken for testing.

Who Should be Screened for Syphilis?

• Men who have sex with Men
• Injection drug users
• Sex trade workers and their clients/partners
• Partners with a known case of syphilis
• Those who have been diagnosed with another STI
• Those who have sexual contact in or with partners from endemic areas.

How is Syphilis Treated?
In most cases syphilis can be treated with penicillin. It is extremely important to follow-up with your healthcare professional after treatment, to make sure that your treatment has been successful. It is also important to notify any sexual or needle-sharing partners from the last three to twelve months of your syphilis diagnosis. They will need to know so that they can see their healthcare professional.

What Can be Done?
We are at a crossroads in the control of syphilis in Canada - but which way will we go? Will the rates of syphilis continue to increase? Will this lead to a resurgence of HIV infection in Canada? Enhanced efforts to screen those who are at risk, diagnose and treat those who are infected and rapidly responding to outbreaks can help to point us in the right direction - the elimination, rather than the resurgence of syphilis in Canada.