Syphilis is on the rise in Australia and in other parts of the world despite being very easy to treat. It is particularly common in men who have sex with men (MSM) living in major cities as well as Aboriginal and Torres Strait Islander (ATSI) people living in Northern Australia. In ATSI people this STI is much more common acquired through heterosexual sex and the group most at risk is women aged 15 to 19 years old. How do you get Syphilis? Syphilis is almost entirely transmitted through sexual contact and affects different parts of the body depending on the type of sexual exposure. It can affect the penis, vulva, anus, mouth or the cervix of the vagina and the first sign of syphilis is called a chancre. A chancre starts of as a small red lump on the skin that quickly becomes an ulcer. It can be sore but in 75% of cases it is completely painless and because it can be inside the mouth, anus or vagina it is common for people to be completely unaware of it. It usually develops within a week or two of sexual exposure but it may take months to happen. Once a chancre has developed it goes away by itself after a month or two. Syphilis can also be spread from a pregnant mother to their unborn baby but this is incredibly rare in Australia. How is Syphilis diagnosed? Syphilis can be diagnosed via a blood test or by swabbing a chancre sore if one is still present. Once a person has been infected with syphilis their blood test will always come back positive for this infection even after they have been cured. In case of a positive blood test result however, a titre is reported that measures the degree to which your body’s immune system is responding to the infection. After treatment this titre drops quite significantly and it rises again if a person is re-infected. Blood tests showing stable syphilis titres that aren’t going up suggest a person has not been re-infected. Who should be tested for Syphilis? Anyone presenting with genital ulcers should be tested for syphilis as well as anyone with a rash that affects the palms of the hands and the soles of the feet. MSM should be tested annually and up to 4 times per year depending on level of risk. Testing is also recommended for anyone concerned about having developed a sexually transmitted infection (STI), in pregnant women, in sex workers and in migrants from other countries. What happens when you get Syphilis? Syphilis is a very complicated infection that causes different symptoms depending on one of four stages. Primary syphilis is the first stage and includes the development of a chancre sore or sores. The Secondary stage develops between 3-6 months after the initial infection and some people will still have a chancre sore that hasn’t yet healed. In the secondary stage people develop fevers, swollen lymph nodes all over their body and a rash that is unusual in that it affects the palms of the hands and soles of the feet. There may also be a headache, sore throat and generalised feeling of being unwell that is similar to having the flu. These symptoms may come and go for 1-2 years before syphilis enters a latent stage where there are no symptoms. The early latent stage is the period where a person has no symptoms but has acquired their infection within the last two years. Even though these people have no symptoms they can still transmit the infection sexually. After two years the next stage is called late latent syphilis and people are not infectious at this time. If people with late latent syphilis are not treated they are at risk of developing serious complications that involve the brain, the heart and eyes. How is Syphilis treated? Prior to the discovery of penicillin in the 1940s, syphilis was much more common. Today it is still very effectively treated with penicillin or doxycycline for those with allergy to penicillin. The treatment is delivered by way of a single intra-muscular injection of penicillin or a two week course of doxycycline tablets. The treatment of more advanced syphilis that might have affected the eyes or brain for example will usually require consultation with an appropriate specialist. Some patients will suffer a reaction 3-12 hours after treatment with whole body shivers and headaches. This passes within 24 hours and is called a Jarisch-Herxheimer reaction. An important part of treatment is also identifying and treating sexual partners of the patient from the previous 3-6 months depending on the stage of this infection. Syphilis may not cause any symptoms for up to 3 months after infection occurs so it is important that sexual contacts are treated even if they don’t have any symptoms. What follow up is needed? Follow up testing is needed after treatment for syphilis to confirm cure. If the blood test shows a two titre reduction than cure is confirmed and if the titre rises again after treatment this most likely represents a new infection. The blood test to check for cure is done at three months and patients should continue to be tested every three months while they are at risk.