Dr Steve Chapman is Better2Know’s medical consultant in Spain and has kindly answered some frequently asked questions for us about Syphilis.  He also acts as our virtual consultant and speaks to our patient’s online and over the telephone.

Dr Chapman is the author of several original scientific publications in the field of STIs and has been involved in over 150 clinical trials during his work in the pharmaceutical industry.  Born and trained in the UK, Dr Chapman has worked for 20 years in Spain where he became the medical director of his own STI clinics in Madrid and Barcelona.  In 2016 he won a national prize for clinical excellence in the field of healthcare.

Dr Steve Chapman answers questions on syphilis

Q: What are the first symptoms of Syphilis?

The most important thing to remember is that in the majority of cases a person with early syphilis infection will not have any symptoms. This early stage, called primary syphilis. We always say that the first symptom will be a small painless ulcer at the site of infection. But as this sore is painless, you have to see it to know if you have it. If you get syphilis through oral sex, for example, then you may not even see this sore inside your throat, and the same is true of primary syphilis in the vagina or anus. In my own experience, only about 25% of people who go on to develop secondary syphilis remember having had some kind of primary syphilis lesion.

This ulcer usually appears some weeks after the initial infection and lasts a few weeks more. Once it disappears, some people think the whole process has ended but in fact, the infection is moving on to the next stage.

Q: Could you explain how Syphilis progresses?

After a person has gone through primary syphilis they will move onto secondary syphilis, but it is common that the infection can enter a latent state where you are unaware of the disease but still can transmit the bacteria to other people on sexual contact. Secondary syphilis is when the infection has moved round the body. It sounds more dramatic but in fact is just as easy to treat with antibiotics as primary syphilis. Since it is a generalised infection, it is common to feel unwell, have fever, skin rashes etc. If untreated, the patient would experience several outbreaks of secondary syphilis over several years. But this is not common, as usually people seek help and get tested and treated.

Q: Which symptoms of Syphilis are lesser known?

The most important message to answer this question is to remember that a very huge percentage of people infected with syphilis will not have symptoms and will therefore be unaware that they are infected. On the other end of the scale there are very unusual but rare clinical forms of syphilis, such as peculiar skin rashes, brain involvement (neurosyphilis) but these are unlikely scenarios, and it is probably better to focus on common patterns.

Q: What are the main concerns voiced by those who test positive for Syphilis?

Getting diagnosed with syphilis upsets patients even though it is extremely easy to treat and with no long-term effects if it is caught early. But it is difficult to shake of the historical context of syphilis, that it was a killer before the age of antibiotics, and when my patients receive this news, they often become very worried, even becoming overly cautious in future sexual contacts.  Unfortunately, having had syphilis does not stop you from getting it again in the future.

As syphilis is transmissible even in oral sex, one other major concern is having to tell sexual partners that they need testing. This requires tact and diplomacy and your specialist can help you with this step.

Many studies have shown if you get exposed to HIV in sex while having syphilis, the syphilis acts as a vehicle for enhanced transport of the HIV virus and increases your risk 5-fold. It is therefore essential to get tested for other STIs if you are diagnosed as having syphilis.

Q: How easily can Syphilis be treated?

Despite the concerns most people have when diagnosed with syphilis, it is usually very easy to treat using common antibiotics. It is common practice to use an injectable antibiotic for most of the cases I have mentioned as the whole process if over and done with in one injection, but sometimes we can treat it with alternative by the oral route. It does not tend to be a difficult to treat infection if it is detected early on.

Q: What are the risks for a pregnant woman who has Syphilis?

Syphilis testing is essential in a woman planning a pregnancy. Getting pregnant while being infected with syphilis causes a host of extremely dangerous problems. The risk of miscarriage is very high, as is stillbirth. More than a third of babies born with syphilis will die shortly after birth, and those who survive will experience severe developmental disorders. Getting tested for syphilis routinely is paramount in women who think they would like to get pregnant. Once treated correctly, the infection would have no impact on future pregnancies.

Q: Do you know any interesting facts or figures about Syphilis?

Comments regarding my experience which I would like to mention as practical tips:

  • Half the people I see with syphilis had no symptoms. Testing is essential
  • Syphilis is transmitted in all kinds of sex, including oral sex, so testing should occur even if there has not been unprotected penetration
  • We see very high level of syphilis between men who have sex with other men. If this is you, make sure you get tested from time to time
  • Tests for syphilis have been around for several decades, but the most recent tests are without a doubt the most precise
  • Diagnosing syphilis in someone who has had the infection in the past is tricky as tests can be difficult to interpret. Get expert help if this is your situation to avoid confusing old test results with current infection
  • Yes, it’s true that many famous people died of syphilis in the past, but please remember that syphilis is treatable with the most basic penicillin and if you get tested and found to have syphilis, we will be able to treat you just fine

Q: What would you say to somebody who can’t decide whether to get tested for Syphilis?

  • Just like all other STIs it is better to know. This is one of the easiest infections to treat and eradicate if you have an early case
  • If you are doubting about getting tested because you haven’t seen any relevant symptoms, don’t forget that silent syphilis is common
  • If you have the infection but don’t get treated, you could pass this on to other sexual partners and they could be a lot sicker than you
  • Discovering syphilis and getting treated normalises your risk of catching other things like HIV (see comment above)

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