Syphilis

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The Issue

Syphilis is a sexually transmitted bacterial infection that was rare in Canada five years ago. However, infection rates are now on the rise. These rising rates are an indication that people are not consistently using safer sex methods.

Background

Syphilis is transmitted through oral, genital or anal sex with an infected person. A pregnant woman with syphilis can pass it on to her unborn child, sometimes causing birth defects or death. Although less common, it can be transmitted through injection drug use or through broken skin on the body.

Cases of syphilis were rare in Canada in the 1990s. In 2002, there were four times as many cases as in 1997 and the number of cases have continued to rise in 2003. Across the country, localized outbreaks of syphilis are contributing to the increasing national rate. Outbreaks have been reported in downtown Vancouver among sex trade workers and their partners/clients, in the Yukon among heterosexuals and in Vancouver, Calgary, Toronto, Ottawa and Montreal among men who have sex with men (MSM).

Syphilis is diagnosed through a simple blood test and is easily treated with penicillin or other antibiotics. Left untreated, syphilis moves through five stages:

• primary
• secondary
• early latent
• late latent
• tertiary

Syphilis is infectious mostly during the primary, secondary and early latent (less than one year) stages. During the latent stage, syphilis may progress into a tertiary infection. It is at this stage that syphilis can do the most damage to the body, affecting the brain, blood vessels, the heart and bones. It can eventually lead to death.

Not everyone infected with syphilis will develop symptoms. That is why it is important to know if you are at risk and how to take preventative action.

Health Effects of Syphilis

Syphilis is often referred to as "the great imitator" because of the wide range of symptoms that infected people may experience. These symptoms can easily be confused with those of other conditions. Also, a doctor may overlook syphilis as a possible diagnosis because the rate of infection in Canada has been low until recently.

In primary syphilis, a painless open sore or ulcer appears at the site where the bacteria first entered the body, usually the genital area, throat or anus. Symptoms can occur within a few weeks or a couple of months after infection. Because the ulcer is painless, you may not know you have been infected. While the sore may go away on its own without treatment, the infection remains and progresses to secondary syphilis.

In secondary syphilis, the symptoms can include:

• patchy hair loss
• a rash on the soles of the feet, the palms of the hands or
  elsewhere on the body
• fever
• swollen glands
• and muscle and joint pain

Again, these symptoms usually disappear without treatment.

Of particular concern is the interaction between syphilis and HIV/AIDS. Individuals with the genital ulcers that appear in primary syphilis are three to five times more likely to contract HIV. Furthermore, people who are HIV positive and also have syphilis are at greater risk of transmitting the infection to others. It can be difficult to successfully treat HIV patients who have syphilis.

Minimizing Your Risk

Following these suggestions may help you protect yourself from contracting syphilis:

• Learn about safer sex and safer injection practices.
• Make informed decisions. Talk to your partner about their STI status and the use of protection.
• Correct use of condoms reduces the risk of STI transmission.
• Ask for a syphilis test. Individuals who are most at risk of acquiring syphilis are:
  • Individuals with more than one sexual partner
    (heterosexuals and MSM)
  • Injection drug users and their partner(s)
  • Sex trade workers and their clients / partner(s)
  • People whose sexual partner has syphilis
  • People who have been diagnosed with another STI
• If you are diagnosed and treated for syphilis, be sure to follow up with your doctor after treatment is done to make sure the infection is gone. It is also important that you or someone from your public health department notify any of your sexual or needle-sharing partners who may have been put at risk of infection. They will also need to be tested and possibly treated.

Health Canada's Role

Health Canada's Sexual Health and Sexually Transmitted Infections Section provides national leadership and coordination of programs, such as surveillance and targeted research studies, that deal with sexually transmitted infections. Working with the provincial and territorial governments, non-governmental organizations and health care providers, Health Canada develops evidence-based national standards and guidelines to direct policy development and promotes the exchange of information for the advancement of sexual health.

Need More Info?

For the information sheet Sexual Health and Sexually Transmitted Infections:
What you need to know about Syphilis and what you can do about it

For the information sheet, Where to go for help

STI Helpline Telephone Numbers

For more information on syphilis, see the Canadian Health Network
and click on Sexuality/Reproductive Health and search for Syphilis

Additional It's Your Health articles
You can also call (613) 957-2991

©Her Majesty the Queen in Right of Canada,
represented by the Minister of Health, 2004
Date of Publication: February 2004