For most of the last several decades syphilis was something Canadian physicians read about rather than diagnosed. That has changed. Rates have climbed substantially across Alberta and elsewhere in the country in recent years, including in northern communities, and cases are now being found regularly in men who had no particular reason to think of it. Congenital syphilis, where the infection passes to a baby during pregnancy, has returned alongside it, which is the clearest sign of how widely it is circulating.
Syphilis is worth understanding for one reason above all: it is very easy to miss and completely curable when it is caught. The infection announces itself briefly, heals on its own without treatment, and then continues quietly for years. Nearly every part of that sequence is designed to reassure a man that nothing is wrong.
How It Progresses
The first stage produces a sore, usually appearing a few weeks after exposure at the site where the bacterium entered — the penis, the anus, the mouth or elsewhere. The characteristic feature of this sore is that it is painless. It is often firm, round, and small enough to be mistaken for an ingrown hair or minor irritation, and it may be somewhere not easily seen. It then heals by itself over a few weeks, whether or not anything is done about it. A great many men never notice it at all, and among those who do, the fact that it went away is usually taken as the end of the matter. The infection, however, has not gone anywhere.
The second stage typically follows within weeks to months. The most recognised feature is a rash, which may cover the trunk and characteristically can appear on the palms of the hands and the soles of the feet — unusual for most rashes and a useful clue. It is often not itchy. Other features include fever, sore throat, swollen lymph nodes, patchy hair loss, fatigue and raised grey lesions in moist areas. This stage is easily mistaken for a viral illness or an allergic reaction, and like the first stage it resolves on its own. The infection remains.
What follows is a latent period with no symptoms whatsoever, which can last for years. Some people remain in this state indefinitely. In a proportion of untreated cases the infection eventually causes serious damage to the heart and major blood vessels, the brain and nervous system, the eyes or the ears. Involvement of the nervous system or the eyes can in fact occur at any stage, not only late, and syphilis is a recognised cause of unexplained vision changes and hearing loss.
Testing and Treatment
Diagnosis is made with a blood test, and it is included in standard STI panels. The interpretation of syphilis serology is more involved than for most infections, since certain tests remain positive for life after an infection has been treated, which is one reason results are best discussed with a physician rather than read off a report.
Treatment is penicillin, given by injection. The number of doses depends on how long the infection is judged to have been present, which is why establishing the likely timing of exposure forms part of the assessment. Men with a penicillin allergy have alternatives, though penicillin remains the preferred treatment and in certain circumstances desensitisation is used so that it can be given. Follow-up blood tests afterward confirm the treatment has worked.
Sexual partners need testing and usually treatment as well. Public health assists with notifying partners, and this can be done without identifying the person who provided the names.
Who Should Be Tested
Testing is appropriate for any man who is sexually active with new or multiple partners, for men who have sex with men, for anyone whose partner has been diagnosed, and for anyone with an unexplained sore, rash or the constellation of symptoms described above. It is also part of routine testing in pregnancy, which matters to men whose partners are pregnant or may become pregnant, since treating an infected partner prevents transmission to the baby.
Syphilis has an unfortunate historical weight to it, and that reputation does more harm than the infection does in a man who gets tested. In practice it is a bacterial infection found with a blood test and cured with an antibiotic, and the only genuinely difficult version is the one nobody looked for.
Confidential STI testing and treatment, including for syphilis, is available from Dr. Raymond Nash at Grande Prairie Men’s Medical Clinic. Appointments can be arranged through gpmm.clinic or at (587) 416-8296. This article is general information and does not replace an individual medical assessment.