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What is it?

Syphilis is a bacterial infection usually (but not always) spread through sexual contact. The bacteria can infect the rectum, cervix, penis, and even the throat. In the U.S. last year, there were about 9.5 cases of syphilis per 100,000 people. Syphilis has a unique historical legacy of being previously very fatal, before the discovery of germ theory and the development of a cure. Because of the infection’s impact on certain brain systems, syphilis patients were often mistaken for people with psychosis, and were thus treated in mental health facilities rather than medical centers. Today, syphilis can be cured with a single round of antibiotics, and as long as the infected person has access to safe and affordable healthcare, a syphilis diagnosis is certainly not as serious as it would have been two centuries ago.

How did I get it?

One can contract syphilis through anal, vaginal, oral sex, as well as sharing unclean sex toys and unsterilized needles. It can also be passed on during childbirth. Additionally, if a mucous membrane (think skin INSIDE the mouth, vagina, anus, and penis) or unbroken skin touches a syphilis sore the disease can still spread easily.

What are the symptoms?

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There are different stages of the disease, and each stage is progressively harder to treat. Once syphilis is cured, any permanent damage to the body remains. Many people never know they have syphilis, which can lead to serious health complications. In the first 10-90 days, or the “primary” infection, a painless sore or sores develop near where syphilis entered your body (so usually near the genitals or rectum). They are usually firm to the touch. 4-10 weeks after the sore(s) appears, one enters a period of “secondary” infection, which usually manifests as a rash on the palms, soles of feet, chest, and back, alongside joint/muscle pain, a fever, and swollen lymph nodes. These symptoms can easily be mistaken for a common cold. In the “latent stage”, 1+ year after the initial infection, there are usually no symptoms, but the person remains contagious. In the “tertiary stage”, 10-20 years after infection, serious complications and diseases in the brain, liver, eyes, heart and bones may develop, including psychotic symptoms. If left untreated and allowed to progress to this stage, syphilis is usually fatal.

What do I do when the test comes back positive?

Your healthcare provider will prescribe antibiotics or injections of penicillin and a follow-up test after to verify that the treatment was successful. Wait until after this second test and for any sores to heal before engaging in sexual activity. It is always important to discuss diagnoses with past and present partners, but because syphilis is life-threatening if untreated, it is absolutely necessary to disclose a syphilis infection. Syphilis is a reportable disease (meaning the US Department of Health collects data on how many cases occur), so your healthcare provider will likely inform you of reporting practices and guide you on steps to contacting to past partners (see “Talking to Partners”). The healthcare provider, not the patient, is responsible for reporting individual cases to the correct organization, which might include both the DOH and the CDC. (

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