Going to the Candy Shoppe - Dr. Dick

Going to the Candy Shoppe

Dear readers,

Before you lick any lollipops this Halloween, check-out my update on syphilis, the oh-so-sneaky bacteria that can spread through oral sex.  

In King County, syphilis seems to really like MSM (Men who have Sex with Men). In fact, last year MSM totaled 87% of all cases. Syphilis spreads from person to person via a chancre (pronounced shaynk-er)--a firm, small, painless sore that shows up 10-90 days after infection. This is the primary stage of syphilis, and it's fully treatable with antibiotics. A chancre can appear on the tongue, lips, anus, rectum, penis, urethra, vagina, and cervix.

Chancres don't usually hurt, so an unsuspecting mister often won't notice the sore, particularly when it's in their anus.  Other times, a person will mistake the sore for a harmless skin bump or a cut. After 3-6 weeks, the chancre will go away on its own. *NOTE: A chancre is not the same thing as a canker sore--the tender sores people get in their mouths.

If untreated, syphilis will enter the secondary stage. This causes a spotty rash that usually appears 3-6 weeks after the chancre appears, though some people get a rash while they still have a chancre. The rash can affect different parts of the body, like the trunk and back, but more commonly, the palms of the hand and soles of the feet. The rash can look very different from person to person...I've even talked to guys who didn't notice a rash. Other symptoms can include fever; swollen lymph glands; weight loss; patchy hair loss; headaches; sore throat; muscle aches; and feeling really tired. About 5% of men will develop loss of hearing or loss of vision at this stage of infection.  If not treated, these problems can be permanent.

The rash and most of the other symptoms of secondary symptoms will go away with or without treatment. Without treatment, a person enters the latent stage, which can last for years. Before there were good antibiotics, about 15% of people who didn't get treatment during the latent stage progressed to develop symptomatic late stage syphilis. This is rare now, but some people can develop brain and spinal cord damage and heart problems.

Since syphilis likes to hide and the symptoms can sometimes be mistaken for other problems, many guys don't know they're infected. If you develop a sore on your butt, dick, or in your mouth, or have a rash or a fever, see a doctor.  It's important to tell your doctor that you have sex with men and that you are concerned about syphilis.  When possible, it's best to see a medical provider who is experienced in treating syphilis, like the people at the STD clinic at Harborview, or a doctor who sees a lot of MSM (Men who have Sex with Men). Also, regular testing every three months is one of the best ways to prevent the serious complications of syphilis.

A blood test is the most accurate way to test for syphilis, as antibodies appear in the blood shortly after infection. Even after successful treatment, low levels of antibodies may stay in a person's blood for months or years. Medical providers can also take a sample from a chancre to test for syphilis.

If you test positive for syphilis, connect with your medical provider right away for treatment. It's very important for your partner(s) to get treated too. *It's risky to try to treat yourself with antibiotics that you buy online or on the street. Effective syphilis treatment requires medical care and a specific antibiotic!

OTHER TIPS....

SCAN BEFORE YOU BOB FOR APPLES:

+ If you're going down on someone, do a quick (and playfully discreet) scan of their package. If you see something you're worried about, consider an oral barrier, or suggest another activity. *Just remember, some STDs can spread even if there are no symptoms! 

WRAP IT:

+ People can get re-infected. Having syphilis doesn't make you immune to getting it again.

+ Condoms, dams, and insertive condoms all provide a shield against syphilis sores. Add some water-based lube on the skin side to increase sensation for your partner. Put some flavored lube on the outside to make it a juicier experience for you. 

+ Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STD. Consider using an oral sex condom if you're deep throating.

IF YOU'RE NOT GOING TO WRAP IT:

+ Avoid brushing or flossing before giving head. This can cause tiny tears in the tissue of your gums and cheeks. Tears provide a nice opening for infections to enter. If you want fresh breath before or after giving head, rinse or gargle with mouthwash. *Mouthwash will NOT prevent you from getting or spreading an STD.

+ Don't give head after going to the dentist. Dental tools can cause tiny tears in your mouth and lips.

IF YOU HAVE HAD SYPHILIS IN THE LAST YEAR:

Guys with syphilis are often at very high risk for HIV infection.  If you've had syphilis in the last year, think about what you can do to better protect yourself.  If you are currently HIV negative, consider talking to your doctor about pre-exposure prophylaxis (PrEP).  PrEP won't protect you from syphilis, but taking it consistently can help protect you from HIV.

Enjoy the candy bowl!

-Dr. Dick

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