Spring is here. Philly Pride is less than one month away. In the next few months, local LGBTQ folks will flock to celebrations of all kinds, basking in the energy and vibrance of our community. Along with this revelry comes the opportunity for new sexual encounters.
At times, this excitement also involves risky behavior, with more likely exposure to sexually transmitted infections (STIs). There was a time these infections were routinely called STDs, or sexually transmitted diseases. But the word “disease” brings with it stigma and fear and can lead to avoidance of testing.
There are many STIs out there — some more common in our community than others.
Chlamydia is the most common STI in our area, with nearly 20,000 cases reported in Philadelphia in 2016. Gonorrhea is up there too (nearly 7,000 cases were diagnosed in 2016). Although still high, these infection rates have been fairly steady in recent years. But I want focus on an infection that is less common, but rapidly increasing in our area and nationally: syphilis.
Once believed to be nearly eliminated, syphilis is on the rise. The most recent data, from 2016, revealed twice as many cases of early syphilis in Philadelphia as there were in 2011. Men who have sex with men (MSM) are disproportionately affected, as are people living with HIV.
Caused by the treponema pallidum bacteria, syphilis is contracted through direct contact with a painless sore, or chancre, which occurs in the early (primary) stage of the infection (about three weeks after exposure) at the site where the bacteria entered the body. Since the sores are painless, and often hidden in areas such as the mouth, vagina or rectum, many people pass the infection on to others before they even know they have it. The chancres usually heal within a few weeks, even without treatment, but that doesn’t mean the infection is gone.
Left untreated, syphilis progresses to the secondary stage, often characterized by rashes on the palms/soles or other areas, or by a wart-like lesion in moist areas. Syphilis earned the nickname “The Great Imitator” because these and other signs and symptoms — fever, sore throat, swollen glands and even hair loss — are often vague, and many are commonly found in a long list of other maladies. The infection is easily transmitted during this stage but, again, the symptoms fade even without treatment. At that point, the infection may go into hiding (latent stage) for a while, with no obvious symptoms. In some cases, untreated syphilis can progress even decades later. At this tertiary stage, it affects critical organs, such as the eyes, bones, heart, brain and nervous system, and can even be fatal. If that isn’t bad enough, syphilis can make HIV transmission more likely. So, you see why we really need to get syphilis infection back under control.
Fortunately, syphilis can be diagnosed with a simple blood test and treated with one or more shots of penicillin (depending on the stage), or with other protocols for those allergic to penicillin. Even better, you can reduce your chances of contracting syphilis with a form of pre-exposure prophylaxis. Similar to PrEP for HIV, PrEP for syphilis involves a single daily ºdose of the antibiotic doxycycline. If you are a man (or transgender person) having unprotected sex with men, have ever had syphilis and are HIV positive, ask your medical provider about doxycycline PrEP. It isn’t 100-percent effective, and if you have a definite exposure, you may still need to be treated. If you are not on PrEP and have a possible exposure (condom breaks, unprotected sex with unknown/new partner, etc.), you may be eligible for post-exposure prophylaxis (PEP) within 24 hours. Anyone with possible symptoms should be tested, and anyone with a sexual partner who is diagnosed with syphilis should be tested and treated presumptively. You should also be screened regularly if you are a man (or transgender person) having sex with men, living with HIV or otherwise at high risk. Anyone who is pregnant should also be screened, as syphilis can be passed on to unborn children.
Of course, some general recommendations still apply. Using latex condoms (or other latex barrier methods), and using them correctly every time you have any sexual contact, is still important in reducing the spread of this and other STIs. Make a point of seeing your healthcare provider and request testing on a regular basis if you are sexually active. Get treated when needed and be sure to follow directions about abstaining from sex for a period of time after treatment (typically seven days).
Shanin Gross, D.O., is assistant medical director at Mazzoni Center. She is also a clinical associate professor of family medicine at Jefferson University and serves as co-chair of the Society of Teachers of Family Medicine’s LGBT Health group. To learn more about Mazzoni Center’s free and confidential walk-in HIV and STI testing, visit https://www.mazzonicenter.org/health-care/community-health/walk-hiv-and-std-testing.