Life After Syphilis Treatment

Syphilis has been around for more than 500 years, and without any effective treatment for many years, this sexually transmitted disease (STD) was a major threat. The only reason syphilis didn't claim more victims was because average life spans were often shorter than the time it takes to reach the final tertiary stage of the disease where fatalities can occur.

For the better part of the past 100 years, syphilis has been a marginal concern thanks to antibiotics, the evolution of sexual health screening and general health practices. Sometimes we think of syphilis as an ailment of the past, but it’s still a widespread STD, and it's been making a comeback.

In 2017, more than 30,000 cases of syphilis were reported in the United States, and these numbers have been on the rise every year. Early detection of the disease makes treatment relatively simple and straightforward, but there are many things to consider once treatment is administered and completed.

Jarisch-Herxheimer reaction

It’s relatively common for people receiving syphilis treatment for the first time, especially among those in the early stages of the disease, to experience what is called a Jarisch-Herxheimer reaction (JHR).

A JHR is a reaction to antibiotic treatment for spirochetal infections or syphilis, Lyme disease or leptospirosis. People experiencing a Jarisch-Herxheimer reaction may have a fever, chills, headache, myalgia and other symptoms within 24 hours of taking an antibiotic.

If you’re receiving treatment for syphilis, you should be notified of the possibility of this response by your doctor and given tips to manage these potential negative side effects.

Contagious period and personal choices

The Centers for Disease Control and Prevention (CDC) reports that syphilis is thought to only be contagious when mucocutaneous syphilitic lesions are present. They become less common over a year after infection, which is the main reason the latent stage of syphilis is broken up into early latent and late latent substages.

This means that syphilis is most contagious and likely to expose sexual partners during the primary, secondary and early latent stages. That said, syphilis can still be contagious during any stage and due to the potential hidden nature of the lesion and sore locations on the body, it can be hard to know whether a person has been exposed.

While penicillin can effectively reduce your ability to infect others within 24 hours of treatment, your doctor may recommend up to three months of sexual abstinence or more to ensure that all lesions have cleared. Your doctor will make the best recommendation based on your input about sexual history and practices.

HIV risk

Syphilis and HIV statistics are often mentioned together because a positive diagnosis of either disease makes it more likely that a patient will contract the other. The correlation between these two diseases involves an intersection of a few factors, but the presence of syphilitic sores is believed to make the transmission of HIV more likely.

As is the case with HIV, syphilis rates are found to be higher among men who have sex with men so certain lifestyles may put a patient more or less at risk of HIV exposure in addition to syphilis. This means that your doctor may want recurring HIV screenings in the months or even years after you’re treated for syphilis.

Follow-up doctor's appointments may likely occur every three to six months with decreasing frequency once you’re confirmed clear of syphilis.

Potential issues for newborns

Syphilis poses a significant risk when passed congenitally to a baby during pregnancy or birth. For women with untreated syphilis, up to 40 percent of births are stillborn.

Additionally, congenital syphilis can cause the newborn to develop skin conditions, jaundice, an enlarged liver or spleen or develop severe anemia.

There has been a serious increase in congenital syphilis, with about a 30 percent increase in cases from 2015 to 2019. For these reasons, your doctor will likely run a test for syphilis early, and perhaps multiple times, throughout your pregnancy.

Talking about sexual health history

Once your doctor gives you the all-clear, you can resume sexual activity as you see fit. There’s no reason you have to mention the former diagnosis to potential partners unless you or your doctor thinks there could be a risk of repeated exposure for you and therefore a chance of transmission to them.

There’s nothing to be ashamed about when it comes to contracting a sexually transmitted disease. Having an STD may lead to reevaluating the way you approach having sex to avoid infecting others, but you shouldn’t be ashamed to talk about your sexual health history with potential partners. While some people may not receive the information well, others may be more receptive and understanding than you think. Ultimately, the choice to disclose your sexual health status or history is yours to make.

Sex comes with a certain degree of risk, and it’s a risk many of us gladly accept. Though we can't do much about the presence of STDs in the dating pool, we can participate in frequent screenings, be transparent about the risk of exposure and contribute to a stronger dialogue about sexual health and sexual practices.