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Healthy Outlook

Syphilis Is On The Rise

Wednesday, August 15, 2012

The English called it the French disease. The French called it the English disease. Clearly there was a social stigma to syphilis infections that has existed for centuries and led societies to blame this condition on the mistrusted foreigner.

Syphilis is a sexually transmitted infection that starts as a painless sore and can develop into a chronic disease that goes through several stages. These highly contagious lesions are usually found on the genitalia, although they can develop in other areas of sexual contact, including the rectum or mouth. Because these lesions are painless, and in women are often inside the vagina, they regularly go unnoticed.

Approximately one in four people with syphilis will go on to develop a second stage infection. Symptoms of this second stage include fevers, headaches, muscle aches, sore throat and swollen lymph nodes. Skin rashes can develop over the entire body, including the palms of the hands and the soles of the feet. Most people with syphilis skip this second stage and go right into the latent phase, which means they are contagious yet do not experience symptoms. Years later, a person with untreated syphilis can develop heart damage, stroke or bone destruction. Pregnant women with syphilis can pass the infection through the womb to the fetus, so it is important to get tested at the beginning of the pregnancy and again soon before delivery.

The discovery and widespread use of the antibiotic penicillin led to dramatic drops in syphilis rates during the 1940s and 1950s. Syphilis remains highly responsive to penicillin treatment. Rates of early stage syphilis in the United States reached an all-time low in 2000, raising hopes syphilis infection could soon be wiped out in this country. Instead, rates have risen alarmingly. U.S. rates in 2009 more than doubled the 2000 rate. In Contra Costa County, there were 33 cases in 2010, compared to none in 2000.

This rise in syphilis cases over the last decade has been primarily among men who have sex with men, although rates of syphilis in women have begun to rise as well. Many of these men with syphilis are co-infected with HIV, the virus that causes AIDS. Both infections are spread through sexual contact, and infection with either virus appears to make it easier to spread the other.

The keys to stopping the spread of syphilis infection include safe sex practices including condom use, frequent testing and early recognition of symptoms. Condoms help, but since these lesions can occur on parts of the anatomy not covered by a condom, they are not 100% effective in preventing infection.

Treatment is easy and usually involves a single dose of penicillin. Abstinence from sex is recommended until follow-up testing confirms the treatment was effective.

Washing and douching after sex will not prevent syphilis, so it's necessary to take precautions. If you are sexually active, especially if you have had multiple partners, ask your health care provider to be tested for sexually transmitted infections including syphilis and HIV. If you notice sores around your genitalia, or a skin rash that involves the palms of your hands, get it checked out right away. Just because the sore or the rash goes away on its own doesn't mean the infection is gone.

Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at For more health information, go to
About the Author
Dr. Chris Farnitano is a family physician and HIV specialist who practices at the Pittsburg Health Center in Pittsburg.