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WHO’s Science in 5 – Syphilis: Protect Yourself and Others

Teodora Elvira Wi: Vismita! We are going to be talking about sexually transmitted infections.

Vismita Gupta Smith: Teodora, that’s going to make people uncomfortable.

Teodora Elvira Wi: I agree! People are rolling their eyes now. But hold on, this is very important!

Vismita Gupta Smith: Alright, what are we talking about?

Teodora Elvira Wi: Syphilis!

Vismita Gupta Smith: We’re going to talk about syphilis today.

So Teodora, last time I heard about syphilis was in some movie, I think Out of Africa. Didn’t Alexander the Great have syphilis? I thought we had this under control?

Teodora Elvira Wi: Syphilis is an ancient disease. In the early days, people died of syphilis and it’s incurable. But now, because of the discovery of benzathine penicillin, syphilis rates are going down in the 1940s. But it’s rising again.

Vismita Gupta Smith: Alright, so why should we be concerned about syphilis?

Teodora Elvira Wi: We should be concerned. Syphilis is increasing. Now we have about eight million syphilis cases this year and also, you will note that syphilis is increasing in pregnant women, affecting their unborn and newborn children. And, most importantly, this can result in still births, prematurity, newborn infections that are going to be there for a long time.

Vismita Gupta Smith: So, we don’t always think about a disease like syphilis. Talk to us about who is at risk and how do you get it?

Teodora Elvira Wi: Well, you get it from sex. Mothers can transmit it to their children and, of course, syphilis can be transmitted through blood, like in a blood transfusion. If you or your partner is having multiple partners, then your likelihood of having syphilis is increased. MSM, ‘men who have sex with men’, and sex workers are also disproportionately affected.

Vismita Gupta Smith: And what are the symptoms of syphilis?

Teodora Elvira Wi: Well, majority of people with syphilis do not have symptoms. Sometimes it’s even unnoticed by the healthcare provider. Untreated, syphilis can be there for a long time, but, of course, it starts with primary syphilis and in primary syphilis, you have a hard chancre. It’s painless. Then it spontaneously resolves. If untreated, you go into secondary syphilis where you have rashes, which are usually not itchy and they are usually found in the palms and in the soles of your feet. It is accompanied by flu-like symptoms and it is also accompanied by lesions in your genitals. This will resolve spontaneously again. Then you go into latent syphilis, where you don’t have any symptoms. This can take a long time. Then you go into the tertiary syphilis, where it affects your brain and your nerves and also your heart.

Remember that with syphilis, it’s the greatest sneaky, imposter disease. It can mimic any infection, but also remember that syphilis can be asymptomatic. So it’s so important to get tested to know if you have syphilis.

Vismita Gupta Smith: Okay, that worries me, that you can have syphilis, that it will keep having some symptoms, then it’ll go away and you can have syphilis and not know it. So when you’re in that latent period, can you still infect others?

Teodora Elvira Wi: Oh, yes! During the time when you’re asymptomatic you can infect others, but you’re most infectious in the primary and secondary syphilis.

Vismita Gupta Smith: Okay, so how do you prevent syphilis?

Teodora Elvira Wi: Syphilis can be prevented, of course. Prevention is key. First of all is, have safer sexual practices. If you think you’re risky, use a condom. Wait, wait, I need to show you this, Vismita. This is the condom, this is so important. You should use them when you are having sex. Also, I think what’s very important because syphilis is treatable and it is curable, get tested and treated if you have high-risk behaviour or you’re in the key population, like MSM, or sex worker, but also, if you’re pregnant, get screened and treated if needed.

We also plead for healthcare providers to please provide respectful and discreet services. And most importantly, I think, for policymakers, they need to provide us with more support on sexual health.

Vismita Gupta Smith: Those are very important points, talk to us about why this disease is not under control.

Teodora Elvira Wi: It’s not under control because culturally we are now having an increase in high-risk behaviour. More people are having multiple partners, there is increasing access to casual sex, there’s decreasing condom use and also, most importantly, other sexual safer behaviour is not being practiced. Most importantly, also, there is already a decreasing access to sexual health, meaning, there’s limited sexual health services but also, people who have STIs or syphilis are very adamant not to go to a service because of stigma and discrimination.

Vismita Gupta Smith: Thank you, Teodora. Tell our audience, what is it that we need to do to prevent syphilis?

Teodora Elvira Wi: Prevent it by having safer sexual practice, use the condom and test and treat.

Vismita Gupta Smith: Listen to Teodora. Stay safe, stay healthy and stick with science.