Syphilis: It's serious. And it's here.

Across Canada, cities have seen a huge rise in syphilis over the past seven years. In most cities gay and bisexual men have been hit hardest by it, and as many as 1/2 of syphilis cases are among men who are HIV positive. Syphilis can easily be tested and treated if caught early enough.

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What is syphilis?

Syphilis is a sexually transmitted infection (STI) that is caused by bacteria. It is easily transmitted during sexual activity. It goes through three different stages after infection, with different symptoms at each stage.

How is syphilis spread?

Can also be spread through oral sex and kissing.It’s spread when your skin—especially mucous membranes like those found in your mouth, throat, penis, ass, frontal genital area (for trans guys) and the top inside of your nose—comes into direct contact with syphilis sores or rashes. It can be spread through oral sex (sucking or getting sucked), anal sex (fucking or getting fucked), frontal/vaginal sex, and any other sexual activities that may involve contact with syphilis sores, or with semen (cum), blood or frontal/vaginal fluids.

Sharing injection, smoking and/or snorting drug use equipment, can also pass syphilis from one person to another. Trans guys should take note that sharing needles to inject hormones is also considered a high risk activity.

How do I know if I have syphilis?

You may have syphilis and not know it. While some people develop visible symptoms of syphilis infection, others don’t. Depending on where you are having sex, you might not be able to see if your sex partner has symptoms of syphilis. Symptoms or not, if you have syphilis you can still get very sick and give syphilis to others.

Stages of syphilis infection:

  • About three weeks (anywhere from 10 to 90 days) after you have sex with someone who has syphilis, you may develop a painless sore (called a ‘chancre’) on your penis, near your anus (ass, bum), in your throat, or for trans guys, the frontal genital area. You may or may not notice that you have a chancre. The sore may go away by itself after 3–6 weeks; however you are still infected with syphilis. It’s very easy to pass on syphilis to someone at this stage of infection. This is referred to as the "primary" stage.
  • Four to 10 weeks after the chancre appears, you may notice a red rash on your chest, palms, genitals, or the soles of your feet. You might also have muscle and joint pain, fever or patchy hair loss. These symptoms may also disappear without treatment, but you can still pass syphilis on to sex or drug partners. This is referred to as the "secondary" stage.
  • If syphilis isn’t treated in the secondary stage you can still pass it on to sex or drug partners for a year from the time you got syphilis, even though you don’t have any symptoms. This is referred to as the “early latent” stage.
  • Finally, there is a long period without any symptoms. However, the syphilis bacteria continue to live in your body and can cause serious damage to your heart, brain, eyes and bones. It may take from 10 to 30 years before this damage is seen but can occur much earlier if you also have HIV. Fortunately, syphilis can be detected and treated before it reaches this stage. This stage is referred to as the “late” or “tertiary” stage. It is less likely that you will pass on syphilis to someone at this stage of infection. Of great concern has been the appearance of cases of tertiary syphilis among those who are HIV-positive, within a very short period of time (six months after infection with syphilis, as opposed to 10 to 30 years).

Undiagnosed syphilis is a lifetime infection and, if ignored, has very serious outcomes.

How can I find out if I have syphilis?

The most common means of detecting syphilis is through a blood test. Also, your doctor or the lab may be able to examine fluid from the chancre under a microscope (if one is present). If you are HIV-positive, it may be more difficult to detect syphilis in your blood. In this case, your doctor should also ask for a "confirmatory" test.

Treatable if caught early. Get tested.Can syphilis be cured?

Yes! If it’s caught early, syphilis can be easily treated with antibiotics, usually by injections. A series of blood tests after you are treated will confirm that the treatment worked for you. It’s important to get these follow up blood tests. The treatment for syphilis is free.

How can I protect myself from syphilis?

Using a latex condom if you have anal sex, or for trans guys, frontal genital sex not only protects you from HIV transmission, but it can also protect you from syphilis when the condom covers up the sores caused by syphilis.

Using a condom when you have oral sex can also provide protection. There are flavoured and dry (non-lubricated) condoms available for oral sex. For sex with trans guys, there are barriers for oral sex such as dental dams or a condom cut up the side.

Don’t share injection, smoking and/or snorting drug use equipment, or share cigarettes. Trans guys should take note that sharing needles to inject hormones is also considered a high risk activity.

Get tested for syphilis regularly if you have more than one sexual partner. Talk to your doctor about your sex life and how often you should be tested for syphilis (and other STIs).

If you’ve had syphilis once, you can get it again—and again. That’s why it’s important to get tested regularly, especially if you have a lot of casual sex.

If you find out you have syphilis, it’s important to follow up with the treatment and see your health care provider for follow-up testing at three months, six months, 12 months and 24 months to ensure the treatment is effective.

If someone you had sex with tells you they have syphilis, get tested. Even if the test is negative for syphilis, you should be treated – you might be infected but the syphilis has yet to show up in the test. If you’re worried about telling a sexual partner that they may have gotten syphilis, you can contact your local public health department and they can tell them without your identity being disclosed.

What if I have HIV?

If you've got HIV, syphilis can hit you harder and faster.Syphilis is spread through intimate body contact including skin-to-skin contact as well as unprotected oral, anal and, for trans guys, frontal genital sex. You can get syphilis more than once.

You might be surprised by the number and variety of symptoms syphilis can cause. If you are sexually active and feel unwell, ask your doctor about testing for syphilis.

You may have syphilis and not know it. Some people develop visible symptoms of syphilis infection, such as a sore or rash but others don’t.

Syphilis makes you more likely to transmit HIV to sex partners. Many STIs including syphilis will increase the amount of HIV in your blood, semen and for trans guys frontal genital fluids, making it easier to transmit HIV. Similarly, if you have HIV your immune system may be less able to control the amount of syphilis bacteria in your body making syphilis easier to pass along to your sex partners as well.

Syphilis infection may take longer to treat and cure.

Syphilis may increase your 'viral load' (a measure of HIV in your blood). This can speed up the rate at which HIV damages your immune system.

If your HIV is not being well-controlled through medications, and your CD4 counts are lower, this can put you at risk for getting neurosyphilis (syphilis infection of the brain or spinal cord), which can lead to dementia, vision problems, lack of coordination, and stroke.

Get tested

It's important to get tested regularly for syphilis. Normally, this is a blood test. Your doctor may not test you regularly for syphilis. Ask your doctor for a syphilis test. It’s easy to add syphilis testing into your routine blood work. You can also test at a clinic if you are not comfortable testing with your doctor.

Get treatment

If you find out you have syphilis, it’s important to get treated right away and then follow up with your doctor to make sure the treatment worked.

You may be concerned about getting tested because of concerns Public Health might contact you if you have syphilis. Whether you’re HIV–positive or –negative, Public Health requires that your sex partners be notified (if you know their names or contact information). Your partner(s) will not be given your name by Public Health. Certain healthcare providers have a legal duty to inform Public Health when you test positive for certain sexually transmitted infections (STIs). Depending on the circumstances, Public Health may let you or your doctor notify your sex partners.

Even with these concerns, it’s extremely important that you get tested and treated for syphilis. Left untreated, syphilis can cause you to get very, very ill. Syphilis will not go away if left untreated. Some symptoms may go away but syphilis will remain and can slowly cause damage to your body.

For more information about issues related to privacy and public health, pick up a copy of “HIV Disclosure: a legal guide for gay men in Canada,” from your community AIDS service organization, view it online, or order a copy from the CATIE Ordering Centre.

Does syphilis increase the risk of getting or passing on HIV?

Yes. If you are HIV-negative, syphilis causes sores (chancres) and rashes, so it's easier to get infected with HIV during sexual activity. Your risk for HIV infection is increased from three to four times if your sexual partner is infected with syphilis and is also HIV-positive.

If you’re HIV-positive and you have syphilis, this can increase your ‘viral load’ (a measure of HIV in your blood). Also, the HIV tends to concentrate in syphilis chancres, increasing the risk of HIV transmission.

Where can I get a syphilis test?

You can get a blood test for syphilis from your doctor.

If you don’t have a doctor, or want to get tested somewhere else, click on the province you’re in to be taken to a listing of local clinics:

AIDS & Sexual Health Info Line
Toll-free: 1-800-668-2437
Local: 416-392-2437
Mainline: 1-800-686-7544

Montréal: Clinique l’Actuel

New Brunswick Sexually Transmitted Infections (STI) Information Line
Call: 1-877-784-1010

More information on syphilis and sexual health for gay men

Syphilis – in-depth fact sheet
Pozitively Healthy: a gay man’s guide to sex and health in Canada – a frank and fresh look at the issues and questions surrounding sexual health for HIV-positive gay men
Preventing and treating sexually transmitted infections in both partners from Managing your health
Sex and the Poz Gay Man – pointers for poz gay men on how to remain healthy and horny
The Story of Syphilis – the STD that’s making a comeback
STI: Sexually Transmitted Infections [Booklet] – This booklet discusses the spread, signs and symptoms, causes, effects and treatments of sexually transmitted infections (STI). The types of STIs covered include: chlamydia, gonorrhea, trichomonas, pubic lice and scabies, genital herpes, genital warts (HPV), hepatitis B, syphilis, and HIV/AIDS. It also includes information on how to use male and female condoms.

About the Campaign

 Poz guys look out!The Attack of the Cursed Syphilis campaign was originally developed by the AIDS Committee of Toronto (ACT) with the marketing firm Due North Communications. Additional elements of the campaign were developed by the Gay Men’s Sexual Health Alliance (GMSH) in collaboration with ACT and Due North Communications. To respond nationally to the syphilis epidemic, CATIE secured funding from the Public Health Agency of Canada for national dissemination.

The campaign creative is a humorous and ‘campy’ satirical twist on 1950’s B movie and horror film publicity materials. The actual design and slogan emulates the original Hollywood B-Movie poster ad for the “Creature from the Black Lagoon”. The visual creative is designed to jump off the printed page or computer screen, to grab the attention of the audience.

The campaign creative is intended to use humour as a means of raising an uncomfortable topic for many gay men. The visuals were purposely designed so as not to look like any current HIV/STI health advertising, so as to catch the attention of gay men, and to stand out within a ‘crowded’ advertising market.

The campaign was originally developed for a Toronto audience of gay men. As the campaign expands in scope we hope that all men who have sex with men (MSM) will become exposed to the campaign and its associated messages.

AIDS Committee of TorontoGay Men's Sexual Health Alliance