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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).

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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 2017 and 2018, the number of reported primary and secondary (P&S) cases in the United States increased by 14.4%, and there were 35,063 P&S syphilis cases reported in 2018. Most (64%) 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: [email protected]

American Sexual Health Association (ASHA)external icon
P. O. Box 13827
Research Triangle Park, NC 27709-3827
919-361-8488

Related Content

  • Clinical Advisory: Ocular Syphilis in the United States (October 16, 2015)

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, 2017. Atlanta, GA: Department of Health and Human Services; September 2018.

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.

STDs are spread through sexual contact — like oral, anal, and vaginal sex. STDs are common, and often don’t have symptoms. There are ways to prevent and treat STDs.

Do I need to worry about STDs?

You may have heard of sexually transmitted infections like gonorrhea, chlamydia, herpes, HIV, and others. STDs are super common — most people will get one at some point in their life. And young people between the ages of 15-24 have a higher chance of getting an STD than anyone else. Some of the most common STDs (like gonorrhea and chlamydia) can be cured with antibiotics, and aren’t dangerous if you get treatment right away. But others can cause serious health problems, especially if you don’t get treatment.

Even though STDs are common, sometimes people feel a lot of shame and embarrassment when they get one. But STDs are like any other infection that gets passed from one person to another — sex just happens to be the way they’re passed.

So if you do get a STD, it doesn’t mean you’re “dirty” or a bad person. You’re just one of the millions of people who got an infection. And like other infections, there are medicines to help you stay healthy if you do get an STD. There are also things you can do to protect yourself from STDs.

How do I prevent STDs?

The only 100% guaranteed way to avoid STDs is to not have any kind of sexual contact — like vaginal, anal, or oral sex, or skin-to-skin genital touching — with another person. No sex = no STDs. But if you do have sex, safer sex lowers your chances of getting an STD.

Safer sex means using condoms, internal condoms, or dental dams. These barriers help block fluids and some skin-to-skin touching that can pass STDs. You can use condoms for vaginal sex, anal sex, and oral sex on a penis. You can use internal condoms for vaginal sex and anal sex. And you can use dental dams for oral sex on a vulva or anus. Read more about using condoms and dental dams.

Not having sex at all, or using condoms if you do have sex, are 2 of the best ways to prevent STDs. But there are other things you can do too:

  • Get tested for STDs. If you do have an infection, you can get treatment so you stay healthy and avoid spreading the STD to other people.

  • Talk to your partner. Good communication, especially about safer sex, can help you build trust and bring you closer together.

  • Choose sexual activities that are less risky. There are lots of ways you can be sexual and stay safe. Masturbation, dry-humping (rubbing genitals with clothes on), talking sexy, and cuddling are just some of the things that you can do that won’t spread STDs.

If your partner doesn’t want to use condoms or help prevent STDs, then they’re not respecting you. If someone really cares about you, they’ll want you to be safe. And it’s not OK for anyone to pressure you to do anything sexual you’re not comfortable with, even if you really like or love each other. Get tips on talking to your partner about safer sex.

How are STDs spread?

STDs are usually spread by having vaginal sex, anal sex, or oral sex without using protection (like a condom). But it’s not always that simple — there are many STDs, and different STDs are spread in different ways.

Some infections are spread through body fluids like semen (cum), vaginal fluids, and blood. Others can also be passed when the skin of your mouth or genitals rubs against the skin of someone else’s.

So basically: any type of sexual contact that involves body fluids or touching genitals can put you at risk for STDs. That’s why using condoms and other barriers (like dental dams) makes sex safer — they help block skin and fluids that can spread STDs.

Vaginal sex (penis-in-vagina) and anal sex (penis-in-butt) are especially risky if you don’t use a condom — using a condom makes them much safer. Oral sex (mouth on a vulva, penis, or anus) can also spread certain STDs (like herpes or HPV). Using condoms and dental dams for oral sex can help protect you and your partner.

Some STDs (like HIV) can also be spread by sharing needles (like for drugs, piercings, or tattoos), or to a baby during childbirth or breastfeeding. But you can’t get STDs from casual contact like hugging, holding hands, or toilet seats. You can only get an STD from contact with semen, vaginal fluids, blood, or skin-to-skin genital touching.

STDs can’t appear out of thin air – you can only get an STD from someone who already has one. But many people who have an STD don’t know it, because a lot of times there aren’t any symptoms. That’s why getting tested for STDs and using condoms is so important.

How can I tell if someone has an STD?

The ONLY way to know for sure if you or someone else has an STD is to get tested. Most of the time, STDs don’t even have any symptoms. So just looking at someone’s penis or vulva can’t tell you whether they have an STD. People with STDs may look and feel totally normal — but they can still give the infection to someone else.

Sometimes STDs do cause problems that you might notice. Get tested for STDs if you have any of these symptoms in or near your genitals:

  • pain

  • swelling

  • weird bumps, sores, or rashes

  • itching and/or burning

  • Pain or burning when you pee

  • discharge from your penis

  • vaginal discharge that has a different smell, color, or texture

  • bleeding from your genitals (that isn’t your period)

These symptoms don’t always mean you have an STD. Other health problems can cause similar symptoms. For example, burning while you pee could be a UTI. Weird discharge might be a yeast infection. The only way to know for sure what’s going on is to visit your doctor or a Planned Parenthood health center.

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What to know about parasites

Worms, or helminth organisms, can affect humans and animals.

Anisakiasis: This is caused by worms that can invade the intestines or the stomach wall. The worms are passed on through contaminated fresh or undercooked fish and squid.

Share on PinterestRoundworms can be passed on by raccoons.

Roundworm: Ascariasis, or a roundworm infection, does not usually cause symptoms, but the worm may be visible in feces. It enters the body through consuming contaminated food or drink.

Raccoon roundworm: Baylisascaris is passed on through raccoon stools. It can affect the brain, lungs, liver, and intestines. It occurs in North America. People are advised not to keep raccoons as pets for this reason.

Clonorchiasis: Also known as Chinese liver fluke disease, this affects the gall bladder. Humans can become infected after ingesting raw or poorly processed or preserved freshwater fish.

Dioctophyme renalis infection: The giant kidney worm can move through the wall of the stomach to the liver and eventually the kidney. Humans can become infected after eating the eggs of the parasite in raw or undercooked freshwater fish.

Diphyllobothriasis tapeworm: This affects the intestines and blood. Humans can become infected after eating raw fish that live wholly or partly in fresh water. Prevalence has increased in some parts of the developed world, possibly due to the growing popularity of sushi, salted fillets, ceviche, and other raw-fish dishes.

Guinea worm: This affects subcutaneous tissues and muscle and causes blisters and ulcers. The worm may be visible in the blister. As the worms are shed or removed, they enter the soil or water, and are passed on from there.

Share on PinterestHookworms can cause intestinal disease.

Hookworm: These can cause intestinal disease. They lay their eggs in soil and the larvae can penetrate the skin of humans. Early symptoms include itching and a rash. They are most common in damp places with poor sanitation.

Hymenolepiasis: Humans can become infected by ingesting material contaminated by rodents, cockroaches, mealworms, and flour beetles.

Echinococcosis tapeworm: Cystic echinococcosis can lead to cysts in the liver and lungs, and alveolar echinococcosis can cause a tumor in the liver. Humans can be infected after eating foods contaminated by the feces of an infected animal, or from direct contact with an animal.

Enterobiasis pinworm: A pinworm, or threadworm, Enterobius vermicularis can live in the colon and rectum of humans. The worm lays eggs around the anus while a person sleeps, leading to itching. It spreads through the oral-fecal route.

Fasciolosis liver fluke: This affects the gall bladder and liver. It is common in countries where cattle or sheep are reared, but rare in the U.S. It can affect the liver and the bile ducts and it causes gastrointestinal symptoms. It passes from one mammal to another through snails. A person may get it from eating watercress, for example.

Fasciolopsiasis intestinal fluke: This affects the intestines. It can also transmitted when consuming contaminated water plants or water.

Gnathostomiasis: This causes swellings under the skin, and occasionally affects the liver, the eyes, and the nervous system. It is rare, but it can be fatal. It occurs in Southeast Asia. It is transmitted by eating freshwater fish, pigs, snails, frogs, and chicken.

Loa loa filariasis: Also known as loaisis, this is caused by the Loa loa worm, or African eye worm. It causes itchy swellings on the body. It occurs mainly in Central and West Africa and is transmitted through deerfly bites.

Mansonellosis: This is passed on through the bites of midges or blackflies. It affects the layers under the surface of the skin, but it can enter the blood. It can lead to angioedema, swellings, skin rash, fever, and joint problems. It is present in Africa and Cental America.

River blindness: Caused by a worm known as Onchocerca volvulus, this affects the eyes, skin, and other body tissues. It is found near fast flowing water. It is transmitted through the bite of a blackfly. It occurs in South America, but 90 percent of cases are in Africa.

Lung fluke: Also known as paragonimiasis, this affects the lungs, causing symptoms similar to those of tuberculosis (TB). However, it can reach the central nervous system, leading to meningitis. It is transmitted when eating undercooked or raw freshwater crabs, crayfishes, and other crustaceans. It is most common in parts of Asia.

Schistosomiasis, bilharzia, or snail fever: There are different types of schistosomiasis. They can affect the skin and internal organs. It results from exposure to fresh water that has snails in it that are infected with the blood fluke, or trematode worm. The worms are not found in the U.S. but they are common worldwide.

Sparganosis: Humans can become infected if they eat foods tainted with dog or cat feces that contains the larvae of a tapeworm of the Spirometra family. It can lead to a migrating abscess under the skin. It is rare.

Strongyloidiasis: This can lead to severe and possibly fatal immunodeficiency. The parasite penetrates through the skin and affects the lungs, skin, and intestines. It is passed on through direct contact with contaminated soil. It most occurs in tropical and subtropical regions.

Share on PinterestDifferent types of tapeworm can affect the intestines, the liver, or the lungs.

Beef and pork tapeworms: Taeniasis is caused by tapeworms of the taenia family. They affect the intestines. They are passed on by eating undercooked beef or pork.

Toxocariasis: A roundworm transmits this infection from animals to humans. It affects the eyes, brain, and liver. It is caused by accidentally swallowing the eggs of the parasite, for example, when young children play with soil. Nearly 14 percent of people in the U.S. have antibodies, suggesting that millions have been exposed. Most never have symptoms.

Trichinosis: This is caused by the roundworm of the Trichinella family. Infection can lead to intestinal symptoms, fever, and muscle aches. It is passed on by eating undercooked meat.

Whipworm: Also known as trichuriasis, whipworms live in the large intestine. Eggs are passed in feces. It is common all over the world. Humans can become infected when ingesting the eggs, for example on unwashed fruit or vegetables.

Elephantiasis lymphatic filariasis: This is transmitted through mosquito bites. The adult worms live in the lymph system. Infection can lead to lyphedema and elephantiasis, in which swelling can cause disfigurement and disability. In the Americas, it is passed on by the Culex quinquefasciatus mosquito.

Ringworm is sometimes mistaken for a worm, but it is not a worm. It is a fungal infection.

Bang Slang: STD Terms

The only thing worse than having a sexually transmitted disease is having to talk about having an STD. As popular as internet-speak and acronyms are these days, it’s no surprise that there are dozens of nicknames to get around the names of the itchy, drippy, burning afflictions no one wants to talk about, but did you know that many of those STD slang terms have been around as long as the STDs themselves?

Here are the most common nicknames for the most common STDs, with a brief explanation of their origins.

Gonorrhea

  • The Clap– The most slang term of all! Theories about the origin of the nickname “The Clap” include a shortened form of the French term for brothel (‘clapier’) and a primitive treatment that involved clapping the penis between your hands to squeeze out the pus that is common with gonorrhea
  • The Drip/Morning Drip– named after the dripping discharge commonly associated with the infection
  • The Dose– because it can be cured with a single dose of antibiotics (if caught early enough)

Chlamydia

  • The Clam– shortened version of the name chlamydia that plays on the use of “clam” as a euphemism for female genitals
  • Gooey Stuff– a very visual and pretty self-explanatory name inspired by the milky or “gooey” discharge associated with chlamydia

HIV/AIDS

  • The Virus– named after the fact that HIV is a lifelong viral infection
  • Hi-Five (Hi-V), from the ‘Hi’ combined with the Roman numeral V for five
  • The Bug– a common nickname for a virus
  • The Deadliest Catch– a play on the name of a popular TV show that indicates the potentially life-threatening nature of an HIV/AIDS diagnosis

Herpes

  • Fever Blister/Cold Sore– common nickname the lesions caused by oral herpes
  • The Gift That Keeps on Giving– nicknamed for the fact that the infection is incurable and characterized by intermittent outbreaks

Pubic Lice

  • Crabs– when viewed under a microscope, pubic lice look like crabs on steroids
  • Crotch Crickets– another way of saying there are lice in the genital region

Syphilis

  • The Great Imitator– nicknamed for the fact that the symptoms of syphilis mimic the symptoms of other afflictions and were easily misdiagnosed before modern tests were created
  • The Pox– named after the pockmarks that appear in the early stages of a syphilis infection
  • Bad Blood– the affliction poor sharecroppers were told they were being treated for during the Tuskegee Syphilis Experiment when the U.S. Public Health Service studied the effects of untreated syphilis on the black men they purposely infected

To find out if you are at risk for an STD, read more about STD risk factors, jobs that put you at risk for STD exposure, and STDs you can contract even while wearing a condom.

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