Syphilis and HIV (SYPHILIS 2011)


I recently submitted a question regarding syphilis and HIV and you were very brief in your response, indicating that you were confused about my question. Without regard to your opinion about my safe sex practices, the question I was asking was how is it possible for me to test reactive to syphilis, negative for HIV and Hepatitis and my partner to test HIV positive. He has been my only partner in the last 2 years, so the syphilis infection was from him. What I would like to understand is how it is possible for me to be reactive for syphilis and have a negative HIV test. It is suggested that I am beyond the "window period" for seroconversion. There is no doubt that he will also test reactive for syphilis, but those lab results have yet to come in. All I am wondering is how is it possible that I can be reactive to syphilis and negative for HIV when it is clear the infection is from one person?



Thanks for clarifying your question. If you've been completely faithful to your partner for the last two years and recently tested positive for syphilis, you either have had syphilis for quite some time or you contracted it from your partner. (Have you tested negative for syphilis in the past?)

Getting to the crux of your question, let's assume your partner has had some unsafe extracurricular activities and managed to contract both syphilis and HIV. You are wondering how it's possible he transmitted syphilis to you but not HIV. The answer is that syphilis (and many other STDs) is far easier to transmit than HIV. Not every HIV exposure leads to transmission of the virus, even when HIV coexists with another STD! Yes, the HIV-transmission risk increases with a co-infection STD, but that increase does not lead to a 100% transmission rate. So it's entirely possible your partner is co-infected with both HIV and syphilis but only transmitted syphilis to you. It's also important to note that you will need follow-up HIV tests out to six months from your last exposure (unprotected sex) to be certain you have not contracted the virus. You can read much more about this topic, syphilis and HIV diagnostic tests in the archives of this forum, as I've responded to many similar questions in the past. Have a look, OK?

I'll repost some information below about syphilis.

Dr. Bob

Syphilis and HIV Infection Mar 10, 2011

I recently tested reactive for syphilis and have received the appropriate treatment. My HIV antibodies and Hepatitis both were negative. Due to being severely ill for several months, there had been no sexual contact with my partner for about 4 months. He just received a positive result for HIV today and I am completely freaked out. How is it possible for me to be reactive for syphilis and have a negative test result for HIV? My doctor tells me I don't need to be worried because my test is negative, but how can I not worry....can you please help me understand what is going on??????

	Response from Dr. Frascino


I'm not sure I understand what you are asking.

As for what's going on, it seems obvious that neither you nor your partner are practicing safer sex, as you have both contracted separate STDs over recent months!

Dr. Bob

Syphilis worries... Aug 17, 2010

Dear Dr Bob

How long should it take for symptoms of syphilis to go after a course of penilcilin has been administered to an HIV positive patient with syphilis as well? I'm a sex addict and have been infected with syphilis 3 times this year (I have started a 12 step program for the addiction). I abused crystal meth for the 1st 4 months of this year. Would each re-infection be worse than the one before? If the person who infected me had neurosyphilis would I have that too straight away. What is the shortest amount of time syphilis can progress to neurosyphilis in a HIV patient? Can drug damage to the nervous system cause the same neurological symptoms as neurosyphilis? When the skin peels of one's palms is that a sign of progression of the disease or that its dying? Thank you for this amazing resource you have provided. I wish I'd seen it before I got infected with HIV.

Many thanks Andrew Cape Town South Africa

	Response from Dr. Frascino

Hello Andrew,

The clinical course of syphilis can vary considerably from person to person. Add HIV into the equation and things become even more confusing, as HIV severity varies considerably as well and this can effect the course of a concurrent syphilis infection. Three bouts of syphilis within one year is indeed alarming. It's also particularly worrisome because it means you are having unsafe sex. This not only puts you at risk for STDs, but it puts your partners at risk for HIV in addition. I urge you to continue with your 12 step program for addiction and to immediately stop putting others and yourself at risk for STDs including HIV. Latex condoms for all penetrative sex is imperative.

I'll repost below some information from the archives that addresses your concerns.

Play safe.

Dr. Bob

Syphilis and MSM (Men Who Have Sex With Men) April 8, 2008

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.

How common is syphilis?

In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns increased from 2005 to 2006, with 339 new cases reported in 2005 compared to 349 cases in 2006.

Between 2005 and 2006, the number of reported P&S syphilis cases increased 11.8 percent. P&S rates have increased in males each year between 2000 and 2006 and among females between 2004 and 2006. In 2006, 64% of the reported P&S syphilis cases were among men who have sex with men (MSM).

How do people get syphilis?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.

Primary Stage

The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage

Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.

Latent and Late Stages

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10-20 years after infection was first acquired. In the late stages of syphilis, the disease may damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Why should MSM be concerned about syphilis?

Over the past several years, increases in syphilis among MSM have been reported in various cities and areas, including Chicago, Seattle, San Francisco, Southern California, Miami, and New York City. In the recent outbreaks, high rates of HIV co-infection were documented, ranging from 20 percent to 70 percent. While the health problems caused by syphilis in adults are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually.

How is syphilis diagnosed?

Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even after the disease has been successfully treated.

What is the link between syphilis and HIV?

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present.

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.

What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Will syphilis recur?

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after being treated.

How can syphilis be prevented?

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention. Transmission of an STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

The CDC's 2006 Sexually Transmitted Diseases Treatment Guidelines recommend that MSM who are at risk for STDs be tested for syphilis annually.

Where can I get more information?

Sexually Transmitted Diseases - Home Page Syphilis - Topic Page Syphilis - Fact Sheet STDs and Pregnancy - Fact Sheet Order Publications Online

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

CDC National Prevention Information Network (NPIN) P.O. Box 6003 Rockville, MD 20849-6003 1-800-458-5231 1-888-282-7681 Fax 1-800-243-7012 TTY E-mail:

American Social Health Association (ASHA) P. O. Box 13827 Research Triangle Park, NC 27709-3827 1-800-783-9877


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