Syphilis & MSM

Syphilis is a serious sexually transmitted infection that is caused by a spiral bacterium, Treponema pallidum. It is believed that once nearly extinct infection is now being frequently reported in gay and homosexual community. Based on the available data, there has been a 15% increase in the total number of reported cases of primary and secondary syphilis

There are various clinical stages of syphilis; primary, secondary, latent and late. The mode of transmission is usually sexual (i.e. direct transmission of bacterium from an open syphilis sore of an affected person). Physical contact with sores present on the genitals (such as rectum, vagina and anus or other mucous membranes such as lips) can increase the risk of transmission several folds.

Symptomology Of Syphilis

The symptoms of this disease vary significantly; depending upon the clinical stage. Once bacterium multiplies, the affected person usually develops a bump as the first sign of infection (that may resemble a harmless zit or an ingrown hair). In the second stage of infection, the person usually develops a non-itchy rash on the extremities (palms and soles) which may spread to involve the entire body. In most severe cases, it can lead to permanent blindness (or ocular syphilis).

Syphilis and MSM; Should I Be Concerned?

According to the latest statistics reported by Centers for Disease Control and Prevention, investigators suggested that the risk of this disease is fairly high in homosexual (or bisexual) males; owing to the nature of sexual practices. In the year 2014, more than 84% of all the syphilis cases were reported in homosexual or bisexual males (1).

Certain risk factors that may make you more vulnerable to develop syphilis are:

- Males who practice unprotected intercourse (without physical barrier or protection).

- Males who have open sores or hemorrhoids in the anal region.

- Having multiple sex partners can also increase your risk of developing it and other sexually transmitted infections.

- Certain risky behaviors such as history of drug abuse is also strongly related to higher risk of contracting syphilis.

- Men who have other sexually transmitted infections are also at high risk of developing this disease. According to CDC statistics, HIV coinfection is reported in 50-70% cases of patients suffering from primary or secondary syphilis.

How Can You Minimize The Risk Of Contracting Syphilis In A Homosexual Relationship?

Certain strategies or interventions can help a great deal in reducing the risk of syphilis:

- Avoid unprotected chance encounters. Make sure to use a latex condom in chance encounters to minimize the risk of direct physical contact with a syphilis sore. It is imperative to mention that direct contact with sores (that are not covered by the condom) can also lead to the transmission of this disease.

- Maintain a monogamous relationship with a partner who has tested negative for sexually transmitted diseases.

- Make sure to speak to a primary care provider at regular intervals for periodic physical examination (especially if you have multiple homosexual partners). This is important because syphilis bacterium may stay dormant for years without showing any signs of infection; but an infected (yet symptom-free patient) can still transmit syphilis bacterium and infect others.

- Avoid engaging in sexual contact if you have syphilis unless you have completed the treatment course and have negative test results for syphilis.

- Notify your partner/s if you get diagnosed with this disease or other sexually transmitted infection. It is important because it may not manifest noticeable symptoms in some individuals, which may delay diagnosis and treatment.

It is a serious infection that may aggravate the risk of wide range of long term complications if no intervention is sought. For example, syphilis sores can makes it easier to catch other STIs. Therefore, if you suspect that you or your partner is suffering from this disease, get laboratory assessment to confirm the diagnosis.

References

1. Patton, M. E., Su, J. R., Nelson, R., Weinstock, H., & Centers for Disease Control and Prevention (CDC). (2014). Primary and secondary —United States, 2005–2013. MMWR Morb Mortal Wkly Rep, 63(18), 402-6.

2. Ling, D. I., Janjua, N. Z., Wong, S., Krajden, M., Hoang, L., Morshed, M., ... & Ogilvie, G. (2015). Sexually Transmitted Infection Trends Among Gay or Bisexual Men From a Clinic-Based Sentinel Surveillance System in British Columbia, Canada. Sexually transmitted diseases, 42(3), 153-159.

3. Centers for Disease Control and Prevention (CDC. (2013). Notes from the field: repeat infection and HIV coinfection among men who have sex with men--Baltimore, Maryland, 2010-2011. MMWR. Morbidity and mortality weekly report, 62(32), 649.

4. Halkitis, P. N., Wolitski, R. J., & Millett, G. A. (2013). A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. American Psychologist, 68(4), 261.