Syphilis and The One Shot Solution

December 19, 2008
Category: Health

Editor's note:  Frank got such a great response to his post on STDs that we decdided to let him answer one of the key questions people asked in a new post.

A reader asked me about syphilis. It appears he is having a debate with a couple of people about it and is hoping I can settle it for them.

One person thinks that if they catch it early, then only one penicillin shot is what is needed. Another says that it doesn't really matter WHEN you catch it. You should get all three, especially because there is no way of knowing WHEN you actually got it.
This is a great question actually, especially with syphilis rates increasing in many major cities in the United States.

The reader hit on a complicated and confusing area of syphilis.

According to Dr. Jeff Klausner, who heads up the San Francisco DPH - STD section, you are both in the right area, but here is the simple explanation.

If someone finds out they have an early case of syphilis, then the treatment is one dose of medicine given by two injections in the butt (one in each cheek).

If they are unable to tell if it is an early case, then the recommended treatment is 3 doses of medicine given out over three weeks.

This is why it is pretty important that sexually active gay men, have a routine syphilis test every 3 – 6 months. It can help catch the infection early and reduce the treatment discomfort as well as reduce the chances of infecting anyone else.

It is one of the reasons San Francisco launched to make it easy for gay and bisexual men get tested in an easy, confidential and accessible process. Check in your city to see if there is a similar program.

Hope this clears things up.


Tags: Advice, STDs
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As someone who is just getting over a severe case of syphilis, I want to urge eveyone that is sexually active to be sure and get tested regularly for it. I was tested twice over the last year and both results were negative but I guess thats not uncommon for the tests to miss it. Because
my results were negative and the fact that the Doctor that I was seeing was a idiot and didnt recognize the numerous symptoms that I was having it went untreated and turned into Neurosyphilis. Neurosyphilis is syphilis in its late stages where it has got into your spinal cord and is breaking down the blood / brain barrier. At this point it is in a position to do all sorts of neurological damage and some of it can be permanent. Neurosyphilis is harder to treat and requires 2 injections a day for 10 days straight. If you miss a day you have to start all over. After the series of shots most professionals recommend 3 weeks of Doxycycline as well.
syphilis cases are on the rise and everyone should be checked on a regular basis since the symptoms can be very subtle. I was seeing my doctor 2 to 3 times a month and it wasnt caught and there were few indications that I may have had a STD. Fortunately I felt so bad that I didnt feel like having sex so the spread of it would have been minimal if any.
Be safe, Get tested, Enjoy life.

So what EXACTLY are the symptoms (if any?). Please be descriptive as most P.C. sites just say something vague.

The symptoms can be very vague and often times look like other things. With me, early on I had a small abrasion on the head of my penis. I didnt think much of it since I am way bigger than average quite often teeth will scrape across it and i dont always notice in the heat of things. The abrasion didnt go away as fast as it should have. This is when I should have caught it and brought it to the Doctors attention. After the abrasion goes away you enter into a latent stage where you dont have any symptoms but I didnt feel very good and was losing weight. Idiot Doctor just kept writing everything off to being HIV+. After the latent stage I got red spots on the palms of my hands and soles of my feet, This is stage 2 syphilis and if you wait this long to get treatment you will get deathly sick from the shots. I did every day that I got the shots up until about the 8th day. The red spots should have been a big flag for my doctor but he missed them too and sent me home. Said it was the HIV. If your doctor is quick to diagnose everything as HIV, GET ANOTHER DOCTOR ASAP. The spots will go away on there own and once again you thing your OK but this is where it starts getting bad. This is where it becomes Neurosyphilis and the symptoms can be varied. Hearing loss, Ringing in the ears, if you had ringing in your ears before look for changes in the ringing or loudness of it, Balance and co-ordination issues. I didnt notice the balance issues I was having since I was so sick in bed
but when the New Doctor had me walk a straight line one foot in front of the other I fell over. I was nearly deaf in my right ear, Vision problems are also common. At this stage it is in your spinal fluid and breaking down the blood brain barrier so the neurological effects can be numerous and varied. I am 2+ months since I was diagnosed and started treatment and am just now ready to return to work.
If you are HIV+ the odds of syphilis turning into Neurosyphilis are much higher and it will happen sooner than if you are not HIV+. If you dont know if you are HIV+ or not for Gods sake go get tested, What are you waiting for?. Its free, quick and simple anymore. Sure, nobody wants to know that they are HIV+ but the health risks from not knowing, not only to you but to the whole community if you are sexually active are great. I have been HIV+ since May of 1995
Its not a death sentence anymore. Get tested !. If you have unsafe sex, even oral sex and havnt been tested for syphilis or the other STD's for that matter in the last 3 months, GO GET TESTED. Studies have shown that oral sex is a great way to transmit syphilis.
Be Safe, Get Tested, Enjoy Life

I had syph a couple years ago. I had a high profile gay doc in nyc. He missed it, just kept telling me to wait, giving me all these other tests, etc. Finally I went out on my own to other docs, receiving among other diagnosis, cancer. I learned that it(syph) is the great imitator of diseases. Finally, I went to a dermatologist who recognized the spots on my skin as syph, stage two. My doc had done blood tests at the onset of my symptoms, but ignored my titre. He said afterword he thought I had had syphillis and it was just showing up on the test as a matter of course. He never asked me if I had ever had syphillis. I hadn't. I got a shot from him, went home and thought I was gonna die. He said I would have no reaction to the shot. I find out later that some people have an intense reaction due to the dying off of the spirochetes. He never suggested I get tested again. For a gay doc in NYC, Chelsea to be exact, to treat a patient in so flippant and casual a manner, and to miss all the signs of syph, as well as future testing, well, it boggles. I dumped his ass, other people have too. I lost weeks of work and felt terrible. All the while the results of a test were in a file in the docs office. I thought that a gay doc would be the way to go, being gay in NYC. Guess I was wrong.

My Doctor was at a community health clinic in the Gay District. This is the last place that a Doctor should'nt have been able to recognize a obvious case of syphilis or any STD for that matter.
It just goes to illustrate that we cant be too careful and that we we are proative in our health care. There are a lot of Doctors out there that dont have much experience with STD. Mine should have as well at the Gay doctor in NYC but there are many that just dont have the experience.
Also many doctors are overworked and dont spend enough time with their patients. The day that my Doctor was rushing me out of his office was the day that I showed him the rash on my hands and feet, he didnt catch it. We are the ones out there having unsafe sex and its our responsibility to know what the symptoms are and to make sure we are tested every 3 months or when ever you notice anything that might be a STD. Even something as minor as a small change in your voice can be Gonorrhea. You can guess all day long but in the end the only way to know is to get tested, If symptoms persist after a negative test then get tested again. You may have not been past the incubation period when you tested before.

I also had to switch doctors after being misdiagnosed for an STD. My doctor - who is gay - never tested me for what then turned out to be herpes after I had some very obvious symptoms (I found out later). This physician is a leading gay doctor in NYC servicing our community. HIs office is very busy - too busy in fact with patients waiting all the time, appointments feeling very rushed and the doctor always slightly unfamiliar with my previous visits/treatments (that I would need to update him even though it was clearly on my file). Also disturbing was the frequent visits by pharmaceutical reps in the office, pushing their products on the office (which were then pushed on patients). I finally switched physicians after the misdiagnosis to a smaller office - with a doctor that took his time, listened to me clearly without me feeling rushed - in other words, proper medical care. I couldn't beieve the contrast of service from the previous doctor. I understand running an office is not easy with costs skyrocketing, chasing insurance payments, red tape, staffing, etc., but the previous comments here are disturbing if we as patients are just treated as files to be pushed out for the next appointment to make an pateint quota for the day. We all need to stay on top of our physicians and be responsible for our own health, including educating our selves and demanding better service. Stay informed!

A friend of mine told me that while being the caregiver for a friend of his, he told him that once you acquire syphillis, even if you are treated and you recover, blood tests will always show that you were infected at one time with Syphillis. Is this correct?

Many thanks.