Syphilis & MSM (Men Who Have Sex With Men) - CDC Fact Sheet

Once nearly eliminated in the U.S., syphilis is increasing, especially among gay, bisexual, and other men who have sex with men (MSM).

What is syphilis?

Syphilis is a sexually transmitted infection that can cause serious health problems if it is not treated. Syphilis is divided into stages (primary, secondary, latent, and tertiary), and there are different signs and symptoms associated with each stage..

Should I be concerned about syphilis?

Most cases of syphilis in the United States are among gay, bisexual, and other men who have sex with men. (MSM), and syphilis has been increasing among MSM for more than a decade. If syphilis is not treated, it can cause serious health problems, including neuralgic (brain and nerve) problems, eye problems, and even blindness. In addition, syphilis is linked to an increased risk of transmission of HIV infection.

How could I get syphilis?

Any sexually -active person can get syphilis. Syphilis can be transmitted during anal sex and oral sex, as well as vaginal sex. Syphilis is passed from person to person through direct contact with a syphilis sore. In men, sores can occur on or around the penis, around the anus, or in the rectum, or in or around the mouth. These sores can be painless, so it is possible to have them and not notice them. Correct use of condoms can reduce the risk of syphilis if the condom covers the sores. However, sometimes sores occur in areas not covered by a condom. It is still possible to get syphilis from contact with these sores. You cannot get syphilis through casual contact with objects such as toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What does syphilis look like?

Syphilis is divided into stages (primary, secondary, latent, and tertiary), and there are different signs and symptoms associated with each stage. A person with primary syphilis generally has a sore or sores at the original site of infection. These sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth. These sores are usually (but not always) firm, round, and painless. Symptoms of secondary syphilis include skin rash, swollen lymph nodes, and fever. The signs and symptoms of primary and secondary syphilis can be mild, and they might not be noticed. During the latent stage, there are no signs or symptoms. Tertiary syphilis is associated with severe medical problems and is usually diagnosed by a doctor with the help of multiple tests. It can affect the heart, brain, and other organs of the body.

A detailed description of each stage of syphilis can be found on CDC’s syphilis fact sheet.

How common is syphilis among MSM?

Between 2015 and 2016, the number of reported primary and secondary (P&S) cases in the United States increased by 18%, and there were 27,814 P&S syphilis cases reported in 2016.  Most (58%) of these cases were among MSM.

How can I reduce my risk of getting syphilis?

The only way to avoid getting syphilis or other STDs is to not have anal, oral, or vaginal sex.

If you are sexually active, doing the following things will lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis
• Using latex condoms the right way every time you have sex. Condoms prevent the spread of syphilis by preventing contact with a sore. Sometimes sores can occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

How do I know if I have syphilis?

The only way to know is by getting tested. Many men who get syphilis do not have any symptoms for years, yet they remain at risk for health problems if they are not treated. Additionally, the painless sores that show up during the early stages of syphilis often go unrecognized by the person who has them. Individuals who are unaware of their infection can spread it to their sex partners.

How will my doctor know if I have syphilis?

Have an honest and open talk with your healthcare provider about your sexual history and ask whether you should be tested for syphilis or other STDs. Your doctor can do a blood test to determine if you have syphilis. Sometimes, healthcare providers will diagnose syphilis by testing fluid from a syphilis sore. If you are a sexually active man who has sex with men, who is living with HIV, and/or who has partner(s) who have tested positive for HIV or syphilis, you should get tested regularly for syphilis.

What is the link between syphilis and HIV?

In the United States, approximately half of MSM with primary and secondary (P&S) syphilis were also living with HIV. In addition, MSM who are HIV-negative and diagnosed with P&S syphilis are more likely to be infected with HIV in the future. Having a sore or break in the skin from an STD such as syphilis may allow HIV to more easily enter your body. You may also be more likely to get HIV because the same behaviors and circumstances that put you at risk for getting other STDs can also put you at greater risk for getting HIV.

Can syphilis be cured?

Yes, syphilis can be cured with the right medicine from your healthcare provider. However, treatment might not undo damage that the infection has already done.

I’ve been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be reinfected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your healthcare provider is recommended to make sure that your treatment was successful.

Because syphilis sores can be painless and hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be obvious that a sex partner has syphilis. Unless you know that all of your sex partner(s) have been tested and treated, you may be at risk of getting syphilis again from an infected partner.

Where can I get more information?

Syphilis – Fact Sheet

STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348
In English, en Español

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

Sources

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3).

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2016.  Atlanta, GA: Department of Health and Human Services; September 2017.

Centers for Disease Control and Prevention. Primary and Secondary Syphilis Among Men Who Have Sex With Men – New York City, 2001. MMWR 2002;51(38);853.

Centers for Disease Control and Prevention. Primary and Secondary Syphilis – United States, 2003—2004. MMWR 2006;55(269-272).

Centers for Disease Control and Prevention. Unrecognized HIV Infection, Risk Behaviors, and Perceptions of Risk Among Young Black Men Who Have Sex with Men –- Six U.S. Cities, 1994 -1998. MMWR 2002;51(33);733.

Centers for Disease Control and Prevention. HIV Incidence Among Young Men Who Have Sex With Men– Seven U.S. Cities, 1994 – 2000. MMWR 2001;50(21);440.

Centers for Disease Control and Prevention. HIV and AIDS – United States, 1981-2000. MMWR 2001;50(21);430.

Centers for Disease Control and Prevention. Outbreak of Syphilis Among Men Who Have Sex With Men – Southern California, 2000. MMWR 2001;50(07);117.

Centers for Disease Control and Prevention. Notice to Readers: CDC Statement on Study Results of Product Containing Nonoxynol-9. MMWR 2000;49(31);717.

Centers for Disease Control and Prevention. STD Increases Among Gay and Bisexual Men. Reported at 2000 National STD Prevention Conference in Milwaukee, Wisconsin. December 2000.

Centers for Disease Control and Prevention. Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex With Men – King County, Washington, MMWR 1999;48(35);773.

Centers for Disease Control and Prevention. HIV Prevention Through Early Detection and Treatment of Other Sexually Transmitted Diseases – United States Recommendations of the Advisory Committee for HIV and STD Prevention. MMWR 1998;47(RR12);1.

K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, chapters 33-36.