Syphilis is treacherous: symptoms often do not occur at all, go unnoticed or disappear by themselves. However, the bacteria continue to be active in the shadows and can cause severe and even life-threatening damage. Important: Syphilis increases the risk of an HIV infection. Untreated HIV-positive people with syphilis can transmit HIV more easily.
Syphilis is very contagious. It is almost exclusively transmitted during sex - during blow jobs and fucking, whether as bottom or top, during rimming, through shared use of condoms, through all the seeping spots that occur during the disease (and which often go unnoticed, e.g. when they are in the mouth or gut), and also through blood and other bodily fluids. Syphilis increases the risk of an infection with HIV, and untreated HIV-positive people with syphilis can more easily transmit HIV to others.
How can I protect myself?
Condoms for anal intercourse and gloves for fisting reduce the risk of an infection. Important: use a new condom or glove for each new partner. There is a higher risk when giving a blow job. Therefore: look at the cock before you start. Avoid contact with weeping spots or blood. Do not use sex toys with more than one partner or put a new condom on for each new partner or clean the sex toy very thoroughly.
Do not share the same lubricant container with others.
Do not move from one partner to another during anal fingering without washing your hands.
When you often have sex with different partners and/or when you are HIV-positive, get tested for syphilis at least once a year. You can do this anonymously and usually free of charge at the department of public health or a checkpoint, but you can also go to a doctor of your choice. (For HIV-positive people, syphilis can be more severe and must be treated differently).
How a syphilis presents itself
At the earliest one week after sex, it starts with a small red papule, then a coin-sized white crater forms (stage 1): clearly visible on the glans, foreskin, or ballbag, less clearly visible on the tongue or cheek mucosa, not visible at all in the ass. The crater is hard and does not hurt. Then it disappears. The syphilis remains. Usually it goes unnoticed.
When the crater is gone, you already have the syphilis bacteria all over in your body. From there, they send warning signs, but these also disappear again, e.g., fatigue and lassitude, mild fever, headaches, swollen lymph nodes and aching limbs. A non-itching and non-weeping rash is typical. It appears on the body and also affects the palms and feet soles (stage 2). Frequently there are also films on the tongue and in the buccal cavity as well as condyloma. In this phase, the rash, condylomas, blood, and infected body fluids are contagious.
If syphilis remains untreated, the bacteria can cause massive damage to internal organs such as the liver, heart and stomach, to blood vessels, skeleton and joints, and to the central nervous system over the course of many years (stage 3). Typical are hard, rubber-like knots (gummas) that appear all over the body and destroy the surrounding tissue when they break open - sometimes with life-threatening consequences, e.g. if they are located at the aorta.
In people with HIV, syphilis often progresses differently, faster, and more severely: stages are more likely to be "skipped" or occur at the same time, later stages are reached more quickly, distinctive skin conditions are more frequent, as are courses with neurosyphilis, which can lead to deafness, impaired vision, mental deterioration, paralysis and finally death.
Diagnostics and treatment
A blood test detects syphilis at any stage. If the central nervous system is suspected of being affected, the cerebral and spinal fluid should also be examined.
Caution: for people with immunodeficiency (for example, HIV infection), a syphilis screening test may in some cases be "false negative" despite clear syphilis symptoms.
An antibiotic kills the pathogens, but the disease must be treated long enough. It is important to start treatment as early as possible - damage to internal organs cannot be reversed.
Inform as many of your sex partners as possible so that they, too, can be tested and treated, if necessary!
If you are HIV-positive, it is important that your physician is familiar with both syphilis and HIV.