Knocking Out Syphilis in Queensland

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With an outbreak of syphilis in south-east Queensland, it’s time to remind everyone aboutKnock Out Syphilis (for online and web posts) the importance of prevention, testing and treatment writes Peter Watts from Queensland Positive People together with Karen Dorante from the Queensland AIDS Council.

Syphilis is easy to catch and can affect anyone regardless of their sexuality. However, in south-east Queensland a current spike in syphilis notifications among HIV-negative and HIV-positive gay men and men who have sex with men has prompted calls from health and LGBTI agencies for regular testing and increased condom use.

What is syphilis? Syphilis is caused by a bacteria called Treponema pallidum.  Syphilis is a sexually transmitted infection (STI) which if left undiagnosed and untreated can cause very serious long term health consequences, including heart conditions, nervous system breakdown, and death.

Why should I be concerned about it?

In the early stages of infection symptoms may not always occur, this is why it’s important to test regularly for syphilis if you are sexually active. Syphilis is easy to catch, even if you use condoms for sex, since oral sex is also a risk and skin-to-skin contact if syphilis sores (chancre) or a skin rash are present.  Chancre sores are generally small reddish open lesions and can occur just about anywhere, inside the mouth, on the lips, or in the genital or anal areas (and in the rectum) – making them sometimes hard to see and usually they are painless.  These will often heal and disappear within a few weeks, even if untreated, and a person can still pass on syphilis without these.  Other symptoms may also emerge such as swollen glands, fever, headaches, fatigue, muscle and joint aches and pains, weight loss and hair loss. A rash may also occur on your palms and soles of feet or other parts of your body.

Sexual transmission usually occurs during the primary (2-3 months) and secondary stages (2-6 months), so syphilis is highly contagious during these times, but transmission may also occur within 2 years of infection (during early latency*).

The progression of syphilis can occur more quickly if you also have HIV, which can make syphilis harder to treat then. Like all infections it is best to diagnose and treat them early, before they progress to more serious stages.

Testing and prevention

Ask your doctor or sexual health clinic for a test if you think you’ve been exposed. Bear in mind there is an incubation period of 2-3 weeks before an infection can be detected on a test (or be sexually transmitted).  Rapid syphilis tests are also available from QPP’s RAPID clinics in Brisbane and the Gold Coast – results are provided in 15 minutes and no appointment is required (http://www.rapid.org.au/).

If you have previously been treated for syphilis, it is still very easy to catch again. There is no vaccine against syphilis. Condoms may provide partial protection, but this depends on the site or area of infection (such as oral syphilis or in skin contact if there are chancre lesions).  However, condoms will provide genital and anal protection, so it’s still important to use condoms for prevention of syphilis.

If you are having any sex get a yearly test. If are having any condom-less sex, or sex with multiple partners (>10 within 6 months) or group sex, or using recreational drugs during sex – get a test every 3 months (4 times a year). If you are HIV-positive, consider the above testing recommendations as it is best to test every 3 months due to the added impact to and from HIV of having syphilis, or ask for a test at each CD4/Viral Load monitoring visit with your HIV doctor.

Treat early to knock out syphilis, before it knocks you out…

Syphilis is easy to treat (and cure) in the early stages 1 and 2 (with penicillin injections). If further left untreated the condition enters a period (stage 3) of latent infection*, with no obvious symptoms. The infection at this stage is causing serious damage to internal organs such as the heart, brain, liver, nerves and eyes and can lead to blindness and difficulty walking, talking and eating. This is known as tertiary (end stage) syphilis.  Tertiary syphilis is very difficult to treat and is life threatening.

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