To find out more about the current syphilis outbreak in Ireland, Man2Man – the sexual health programme for gay, bi and men who have sex with men – spoke with Dr Naomi Petty-Saphon to find out more about the outbreak, why it was declared and when might it be over.

Naomi is a Specialist in Public Health Medicine with the HSE Health Protection Surveillance Centre (HPSC) and Department of Public Health HSE East.

What is syphilis and why is it important to know about it?

Syphilis is a sexually transmitted infection (STI) caused by a bacteria called Treponema pallidum. It’s important to know about as untreated, it can cause serious health problems in both men and women. 

Why was a syphilis outbreak declared? 

Due to the increasing number of cases of syphilis in Ireland, an outbreak of early infectious syphilis was declared. Cases have been increasing for the past number of years, and although they dropped slightly at the start of the COVID-19 pandemic, they then started to increase and are now higher than before the pandemic. 

What are the symptoms?

There are several different stages to syphilis infection; primary, secondary and tertiary. 

Around 10 days to three months after you have been exposed to syphilis, a small sore or ulcer (called a chancre) appears. The sore will appear on the part of your body where the infection was transmitted, typically the penis, anus, rectum, vagina, tongue or lips.

Most people only have one sore, but some people may have more. For many people, the sore is painless but not always. You may also experience swelling in your lymph glands (such as in the neck, groin or armpit). However, many people don’t notice this stage. The sore will then disappear within two to six weeks and, if the condition is not treated, syphilis will move into its second stage.

The symptoms of secondary syphilis will begin a few weeks after the disappearance of the sore. At this stage common symptoms include:

• a non-itchy skin rash which can appear anywhere on the body, but commonly on the palms of the hands or soles of the feet
• tiredness
• headaches
• swollen lymph glands
• eye problems like pain or blurring of vision

These symptoms may disappear within a few weeks, or come and go over a period of months.

Syphilis will then move into a stage where you will experience no symptoms, even though you remain infected. This is called ‘latent syphilis’. You can still pass the infection on during the first year of this stage, but, after a couple of years, it is unlikely that you would pass syphilis on to others, even though you remain infected. 

The latent stage can continue for many years. Although you are not infectious to others if you are not treated, you risk latent syphilis moving on to the tertiary syphilis, which can have serious health consequences. The symptoms of tertiary syphilis will depend on what part of the body the infection spreads to – it may affect the brain, nerves, eyes, heart, bones, skin or blood vessels. At this stage, untreated syphilis can be serious enough to cause death. 

Cases of latent syphilis that have been present for more than one year, and cases of tertiary syphilis are not infectious and are not notifiable in Ireland. They are not counted as part of this syphilis outbreak.

How do I know I have it?

If you have any of the symptoms outlined above and may be at risk, or if you have had a partner who has syphilis, you should be tested. Syphilis is usually diagnosed by a blood test. A list of STI services can be found here.

Can it be treated?

Yes, syphilis can be treated, which will prevent you from developing the later stages of syphilis and also from passing the infection to others.

What is the treatment?

Syphilis can be treated and cured with antibiotics, usually injections of penicillin. If you are allergic to penicillin, there are other treatments available. Syphilis should be treated at an STI clinic. Once the treatment has finished, the clinic will carry out further blood tests to make sure the infection has gone. 

Does syphilis hurt or is it uncomfortable?

The ulcer/sore that develops at the first stage of syphilis (primary syphilis) can be painful but can often be painless. Other symptoms of primary and secondary syphilis can be uncomfortable, for example, swollen lymph glands and headaches. People often don’t notice the symptoms of syphilis infection. 

Will others know I have it?

If others are familiar with the signs and symptoms of syphilis they might notice you have them, but syphilis symptoms can be non-specific. If you are diagnosed with syphilis you will be advised you should let sexual contacts know so they can be tested too. 

Will it affect me long term?

Untreated syphilis infection can lead to developing tertiary syphilis which can have very serious health consequences. Testing and treatment can prevent tertiary syphilis so it is important to get tested and treated if you are at risk. 

Do I need to stop having sex? Kissing?

If you are diagnosed with syphilis you should not have sex until you have been treated and have a clear test. In general, kissing is low risk and OK, however it is possible that the ulcers caused by syphilis occur around the mouth. In this case the infection could spread to others via kissing. 

How long does it take to recover from it?

Syphilis is usually treated with injections of antibiotics. The number of doses you might need depends on the stage of your infection. This will be discussed with you at the STI clinic. 

https://twitter.com/Man2ManIreland/status/1427618972124463107?s=20

Can I easily pass it to others? How?

Primary, secondary and early latent syphilis are infectious (together these are called ‘early infectious syphilis’, EIS) and can be passed onto others via unprotected oral, anal or vagina sex. Syphilis can also be transmitted via skin-to-skin contact with a syphilitic ulcer/sore. Condoms can prevent transmission, however it is possible for transmission to occur if a sore isn’t covered by a condom. 

Can I get it again or am I immune to it if I already have had it?

Having syphilis once does not protect you from getting it again. If you get syphilis again it is called a ‘re-infection’. 

It is now two months since the declaration of the outbreak, what has happened in those months?

In the past two months three free pop-up syphilis testing clinics were held at HIV Ireland Dublin. The online STI testing service (SH24) has been extended in Dublin, Kildare, Wicklow, Cork and Kerry and it is hoped this will be expanded further. Alerts about the outbreak were also sent to STI clinics, GPs and a range of hospital specialties to raise awareness of the outbreak, and a syphilis communication campaign has been launched. 

What happens next?

The group will examine the epidemiology (who, when, where, how transmission is occurring) of the cases in detail to see who is at risk and what can be done for these groups. We need to make sure people know about the risk of syphilis, that they can be tested if they are at risk, and treated if they have syphilis. This way we can stop the spread to others. 

What are some things we can do to protect ourselves and others from syphilis?

Protect yourself with new partners by using a condom for all anal, oral and vaginal sex. It’s important that both you and any new partners have a sexual health screen before having any unprotected sex (sex without a condom).

If you are having unprotected sex with new partners, it is important to test regularly (for example every three months) for syphilis and other STIs.

When will the outbreak be considered over?

The syphilis outbreak will be declared over when a number of criteria have been met. The group will need to have a good understanding of the characteristics of syphilis cases. An evidence-based plan will be developed by the group to outline what has been done, what more needs to be done, how it will be done, and how we know it has been successful. 

To find a sexual health service near you and to arrange a sexual health check-up visit Man2Man here.