IMPORTANT NOTICE: These “Fast Facts” are presented from a fister’s point of view only. They are not intended to be medical advice or to serve as a substitute for the advice of a competent medical doctor. Please use these facts and the links to other resources as a springboard for your own research into these important issues. The information that follows is not at all inclusive, or the only viewpoint available. You should familiarize yourself with the risks associated with these conditions, means of transmission, and methods for prevention and make your own informed decisions regarding acceptable means for protecting yourself and your health.

Syphilis is a sexually transmitted disease (STD) caused by a type of bacteria called T. Pallidum. It can spread from person to person by physical contact during oral or anal sex, including fisting. Syphilis infections are treatable and curable with antibiotics. How many people in San Francisco have it?
Syphilis was on the decline until 1999 in San Francisco, when there was an outbreak related to an AOL chatroom. Since then (to date in March 2004), there have been almost 1,600 new cases, mostly among men who have sex with men. Each case of syphilis, on average, may have exposed 10 additional people, resulting in over 16,000 people possibly infected or exposed to syphilis in the last four years.

Untreated syphilis can lead to organ damage, including brain damage, and in some cases death. In addition, syphilis infection makes HIV easier to catch or to give to sex partners. New data show that for people who have HIV, syphilis can dramatically increase their viral load and cause a drop in CD4 counts. This increase resolves with syphilis treatment.

Syphilis infection occurs in four stages, named primary, secondary, latent , and tertiary (late).  The symptoms of each stage are discussed below.

Primary Syphilis
Symptoms usually show up 2-12 weeks after being exposed. The first sign is often a skin sore called a chancre (shank-er). You may have more than one, or you may have chancres and not notice them because they are inside your anus or vagina. Chancres can also appear on your scrotum, penis, vaginal lips, anus or in your mouth. They are usually not painful. The sores will go away after several weeks without treatment, but you would still be infected.

Secondary Syphilis
Most people who have secondary syphilis notice a skin rash covering their body 4 to 12 weeks after infection. The identifying feature of this rash is that it shows up on the palms of the hands and soles of the feet. Often it is not itchy. Other common symptoms of secondary syphilis are swollen glands in various areas of the body, fever, fatigue, patchy hair loss, weight loss, and headache. Since these symptoms are so similar to those of many other health problems, syphilis has sometimes been called “the great imitator.”

Additional symptoms during secondary syphilis that are particularly important are syphilis warts and white patches (condylomata lata and mucous patches, respectively). These warts and patches are highly infectious and can occur in moist areas of the body like the mouth, side of the tongue, anus, etc.

Secondary syphilis symptoms usually last anywhere from 1 to 3 months, but sometimes they last longer, and once in awhile the symptoms come and go over a year or two. But even after the symptoms of secondary syphilis clear up, if left untreated, the infection continues in your body.

Latent Syphilis
Latent syphilis causes no symptoms. The infection can be detected only by a blood test. If not treated, latent syphilis continues for life. Many people with latent syphilis never have serious problems, but some progress to the final stage, called tertiary syphilis.

Tertiary (late) Syphilis
About one-third of untreated people with syphilis experience serious damage to various organs and body systems. Tertiary syphilis can appear any time from a year to 50 years after becoming infected; most cases occur within 20 years. The brain, heart, liver, and bones are the most commonly involved organs. Tertiary syphilis can cause paralysis, mental problems, blindness, deafness, heart failure, and death.

If you are a San Francisco resident, you can get tested confidentially and conveniently at by downloading a lab slip and taking it to one of 12 locations in the City to have your blood drawn. You get your results online with a unique ID within three to five days. A complete examination for syphilis in a doctor’s office or clinic includes taking a sexual history, examining any symptoms you might have (chancres, rash, etc.) and a blood test. There are special tests available at City Clinic to diagnose syphilis from sores if they are present.

How is syphilis tested?
Penicillin shots cure syphilis. If you are allergic to penicillin, there are alternative antibiotics. One common alternative is called doxycycline.

Is it safe and effective?
Even though symptoms will clear up after treatment, sometimes the first treatment doesn’t completely cure the infection. It is very important to have several repeat syphilis blood tests to be sure the treatment worked and the infection is completely gone. In most cases this means repeat blood tests one week after treatment, then every few months for the next year.

Your sex partner(s) must be examined and treated too. Otherwise they can give the infection back to you and/or infect others. It’s important to talk to your partners to maintain the sexual health of our community. At City Clinic, once your treatment is completed, we will give you a card that shows proper treatment was given to cure the infection. At this point, you will no longer be contagious and cannot spread syphilis to others. Until then, you need to abstain from sex or use condoms for anal, oral and/or vaginal sex.

The risk for syphilis is directly related to the number of sex partners you have: The more sex partners, the greater the risk on contracting it. Having more sex with fewer partners reduces your risk of getting syphilis. Abstinence is the only surefire way to avoid getting syphilis or other STDs. If you’re sexually active, using condoms consistently and correctly for oral, anal and vaginal sex is your best bet for staying sexually healthy. Also, regular STD checkups at least every six months if you’re sexually active with more than one monogamous partner is recommended. Syphilis and other bacterial STDs are curable with proper diagnosis and treatment.

Courtesy, San Francisco Department of Public Health and the San Francisco City Clinic.