Syphilis in the LGBT Community: Are Signs, Symptoms, and Treatment Different?

1. Syphilis and the LGBT Community?

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Although it affects all population groups, the rate of syphilis infection is higher in the LGBT community, especially among men who have sex with men (MSM), due to certain sexual behavioral characteristics and barriers to healthcare access. This article will help you understand how syphilis manifests in the LGBT group, what differences there are compared to other groups, and what to keep in mind regarding the treatment regimen.

2. Why is Syphilis common in the LGBT Community?

• The rate of syphilis infection in MSM is higher than in the heterosexual group according to CDC and WHO data.
• According to the CDC’s National Overview of STIs in 2023 report, men who have sex with men (MSM) account for one-third (32.7%) of all primary and secondary syphilis cases and 57.5% of all primary and secondary syphilis cases among males in the U.S.
• In 2021, the rate of primary and secondary syphilis in MSM was 106 times higher than in men who only have sex with women (and 167.5 times higher than in women).
• The rate of syphilis infection in the MSM group in Vietnam has sharply increased: from 0.89% in 2008 to 6.7% in 2018.
• According to a study in the Southern region, the current prevalence rate of syphilis in MSM in Ho Chi Minh City increased from approximately 0.5% to about 6.1%; and in the transgender male group, it reached up to 17%.
• Unprotected anal intercourse, multiple partners, anonymous sex, and using dating social media contribute to increasing the risk.
• HIV co-infection is quite common in this group, which alters the presentation and treatment of syphilis.
• Stigma and healthcare barriers cause many people to delay seeking examination or self-treat incorrectly.

3. How is the manifestation of Syphilis different in the LGBT Community?

Syphilis in people within the LGBT community is not fundamentally different; it also presents with signs and symptoms across stages including: Primary Syphilis, Secondary Syphilis, Latent Syphilis, and Tertiary Syphilis. However, there are some points that need special attention:

• The painless ulcer (syphilitic chancre) often appears in the anus, rectum, mouth, pharynx, or genitals. Among these, ulcers in the anus, rectum, or inside the mouth are often missed because they are not visible and are painless.
• Some cases of anal ulcers are misdiagnosed as hemorrhoids or anal fissures.
• Symmetrical red rashes appear on the palms and soles, and especially rashes may appear around the anus, groin, or mouth.
• MSM or transgender individuals may experience pharyngitis, stomatitis, or proctitis-rectal inflammation causing bleeding or painful defecation, which can easily be mistaken for hemorrhoids.
• Many people have no clear symptoms and are only detected during routine screening or when a partner reports being infected.

4. Syphilis and HIV Co-infection in the LGBT Community

In the LGBT community, especially among MSM, the rate of syphilis and HIV co-infection is very high. In the U.S., nearly 40% of people with syphilis are also living with HIV. This means that almost 4 out of every 100 people infected with syphilis also have co-existing HIV. In Vietnam, this number is also increasingly rising.

• Why is co-infection so common?
• Syphilis causes mucosal damage – increasing the risk of HIV transmission by 2–5 times.
• Sharing high-risk sexual behaviors: not using condoms, multiple partners, anonymous sex.
• HIV weakens the immune system, making the syphilis bacterium more likely to ‘attack deeper.’
• Difficulties in diagnosis and treatment:
  • Syphilis in people with HIV progresses faster and can cause neurological complications sooner, even in a recent infection, leading to misdiagnosis or being overlooked.
  • Test results are easily skewed, requiring an experienced physician to read them correctly. In some cases when neurosyphilis is suspected in people with HIV, a lumbar puncture for cerebrospinal fluid testing is needed to check for neurosyphilis.

5. What are the effects of Syphilis on people in the LGBT Community?

When a person in the LGBT community contracts syphilis, they not only face physical health problems but also endure a heavy psychological burden, often leading to depression and anxiety disorders. This is due to a combination of factors from the disease and the social pressures they face.

• Syphilis itself can cause severe psychological problems, especially when the disease progresses to a severe stage, it can cause psychiatric disorders due to neurosyphilis complications such as: sleep disorders, dementia (loss of cognitive ability, behavioral changes), severe headaches, loss of muscle coordination, numbness, or even paralysis. This can also lead to other complex psychological conditions.
• Constant anxiety, insecurity, and fear: People with syphilis often face worries about health complications, the possibility of infecting others, and the risk of reinfection. These worries are common contributors to anxiety and depression.
• The LGBT community is inherently vulnerable to mental health issues due to social factors, and when they contract syphilis, these problems become even more severe.
• LGBTQ individuals are three times more likely to experience psychiatric disorders than heterosexual people.
• LGBTQ youth are four times more likely to have suicidal tendencies, suicidal ideation, and self-harm behavior.
• It is estimated that 38–65% of transgender people have suicidal ideation.
• Many LGBT people may hesitate to seek help from a mental health professional due to fear of stigma or distrust of the healthcare system. Stigma is a major barrier that makes LGBT people hesitant to seek examination, testing, and treatment for STIs like syphilis. The fear of being judged, disclosing personal information or sexual orientation can lead to delays in diagnosis and treatment, increasing the risk of complications and simultaneously escalating the psychological burden.

These effects create a vicious cycle that makes the disease prolonged and easily relapsed.

6. Syphilis Treatment in the LGBT Community

• Syphilis treatment does not discriminate by gender or sexual orientation, but attention must be paid to the additional factors of co-infection with HIV, anal inflammation, and the risk of reinfection.
• Syphilis can be completely cured with injectable medication. Therefore, the earlier the detection, the simpler the treatment, the fewer the complications, and the lower the economic burden.

However, there are some treatment notes in the LGBT group:

• Closely monitor for neurological symptoms if co-infected with HIV.
• Consider screening for other STIs: HIV, gonorrhea, Chlamydia, Hepatitis B, Hepatitis C.
• Encourage partner notification and simultaneous treatment if there was exposure.

When should you get checked?

• Have had anal or oral sex or sex without a condom.
• Have multiple partners, anonymous sex, or sex with partners met through dating apps.
• Feel that the body has a “strange issue” with no clear cause and are worried.
• Have had other STIs (gonorrhea, Chlamydia, HIV, genital warts…).

Get tested every 3–6 months if you consider yourself to be in the above-mentioned risk groups.

7. Syphilis Prevention in the LGBT Community

• Use condoms correctly and consistently, especially during anal and oral sex. Correct condom use is the “best companion” for self-protection.
• Get regular STI testing every 3–6 months if you are at high risk.
• Limit the number of sexual partners, and avoid anonymous sex with people whose health status is unknown.
• Consider using PrEP to prevent HIV – indirectly reducing the risk of STIs through regular screening.
• Living positively, healthily, having safe sex, and getting regular testing is self-love.
• Do not self-treat as it can worsen the condition, increase the risk of drug resistance, and increase disease relapse.

8. Conclusion

Syphilis is a sexually transmitted disease that is dangerous but can be completely cured. The LGBT community, especially men who have sex with men (MSM), is a high-risk group. The signs are often subtle and easily mistaken for other diseases. Syphilis in the LGBT community not only has specific manifestations such as ulcers in the anus and mouth but also has a risk of severe progression if co-infected with HIV. Regular screening every 3–6 months, timely treatment, and increased awareness of prevention are the keys to effective disease control. Be proactive in protecting your sexual health and the community. Syphilis does not choose who to infect and spares no one, whether inside or outside the LGBT community. But you have the right to choose a safe life, proactively check your health to protect yourself, your family, and the person you love.

This article is written by BS. CKI. Võ Nguyễn Duy Hoà, a specialist in General Surgery, Urology, and Andrology. The doctor has many years of experience in the field of reproductive and sexual health.

Reference

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