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).

What is syphilis?

Syphilis is a sexually-transmitted disease (STD) caused by a specific type of bacteria. If not treated promptly and correctly syphilis can cause long-term complications. Symptoms of syphilis in adults are divided into stages. The terms used for these stages are primary, secondary, latent, and late syphilis.

Should I be concerned about syphilis?

Syphilis continues to increase among gay, bisexual, and other men who have sex with men. Recent outbreaks among MSM have been marked by high rates of HIV coinfection and high-risk sexual behaviors (such as sex without a condom, new or multiple partners, and substance abuse). Cases of ocular syphilis have also been reported among MSM. Ocular syphilis occurs when syphilis affects the eye and can lead to permanent blindness. While the health problems caused by syphilis in adults are serious, it is also known that the genital sores caused by syphilis in adults also make it easier to get and give HIV infection sexually.

How could I get syphilis?

Any sexually-active person can get syphilis. Syphilis is passed from person to person through direct contact with a syphilis sore. In men, sores occur mainly on the external genitals, the anus, or in the rectum. Sores also can occur on the lips and in the mouth. As a gay or bisexual man, you should know that you can get syphilis during anal or oral sex, as well as vaginal sex. Sometimes sores can occur in areas not covered by a condom, so you could still get syphilis from contact with these sores, even if you are wearing a condom. 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 has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. This is a symptom of the primary stage of syphilis. The non-itchy body rash that develops during the secondary stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. You could also get syphilis and have very mild symptoms, or no symptoms at all.

A detailed description of each stage of syphilis can be found on CDC’s syphilis fact sheet.

How common is syphilis among MSM?

Between 2014 and 2015, the number of reported primary and secondary (P&S) cases increased by 19%.  Most cases are among MSM. In 2015, 81.7% of the reported male P&S syphilis cases where sex of sex partner was known were among gay, bisexual, and other men who have sex with men.

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 and has negative STD test results.
• 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, so you could still get syphilis from contact with these sores, even if you are wearing a condom.

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 later on 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 may be spreading 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 man who has sex with men, has HIV infection, and/or has partner(s) who have tested positive for HIV, you should get tested regularly for syphilis.

HIV/AIDS & STDs

What is the link between syphilis and HIV?

In the United States, people who get syphilis often also have HIV, or are more likely to get HIV in the future. This is because 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 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 untreated partner.

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Where can I get more information?

Sexually Transmitted Diseases - Home Page
Syphilis - Topic Page
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: npin-info@cdc.gov

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

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, 2015. Atlanta, GA: Department of Health and Human Services; October 2016.

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.