The Robert Koch Institute has recorded a continuous increase in syphilis cases in Germany since 2010. More than 80 per cent of these cases can be traced back to sexual contact between men. To what extent are these figures also reflected in everyday medical practice? An interview with the Berlin general practitioner and infectiologist Dr Christoph Schuler
Christoph Schuler, your patient base also includes a large percentage of gay men. To what extent does syphilis play a role in your everyday practice?
We certainly have a new case in our practice every week on average, and have had one for several years. The number of cases has not necessarily increased in recent months, but it has remained very constant at a high level over a long period of time.
From your practical experience, can you identify certain patient groups that are particularly affected?
We discover a lot of syphilis infections in our HIV patients, if only because they are regularly screened for sexually transmitted infections (STIs).
This means that new infections are detected automatically and at a very early stage.
Correct. On the other hand, there are many non-positive patients who come to us because of suspicious symptoms or who have had a routine STI test done on their own initiative.
Some have also been tested elsewhere, for example at testing facilities in gay counselling centres, and then visited us after being diagnosed. And last but not least, there are also men who have learnt from their sexual partner that they have been diagnosed with syphilis and have therefore had themselves tested.
Does it also happen that the same patient gets infected again and again?
This is indeed the case, but with syphilis in particular it is very difficult to distinguish whether it is a new infection or a flare-up of an inadequately treated infection.
Could the fact that the number of infections is so consistently high or even rising possibly be due to a change in sexual behaviour? Namely that gay men are having more sex without condoms again?
I don't see a direct connection. Of course, condoms are dispensed with more often because HIV treatment is effective.
... and therefore the virus can no longer be transmitted.
Secondly, safe sex with a condom is not a practice that can completely rule out syphilis infection. You can also become infected through kissing or oral sex.
In our practical experience, however, there are certainly scenes in which syphilis infections are more likely to occur, for example in men who are sexually active or go to sex parties. If new infections occur here, they are also passed on quickly. This makes it all the more important to inform your sexual partners if you have been diagnosed with an infection so that your partner can be treated.
Syphilis: Clearly stigmatising character
Syphilis appears to be more morally burdensome than other sexually transmitted diseases. Is it really easier for patients to go to the doctor for gonorrhoea, for example?
That is indeed the case. Patients in particular who have never had to deal with an STI before and only have occasional sexual contact feel quite offended and are sometimes a little shocked. This is clearly due to the stigmatising character that syphilis still has. Even if syphilis is treated: a scar remains visible in the blood for life. But the treatment also differs from that of many other STIs: The injections can be quite painful and - depending on how late the infection was discovered - may need to be repeated at weekly intervals. If you have allergies, daily infusions or several weeks of tablets may also be necessary. The treatment of gonorrhoea or chlamydia, on the other hand, is much simpler and less complicated.
Unlike with hepatitis A, for example, once you have recovered from syphilis you are not automatically protected from a new infection. How do people deal with it if they catch it more than once?
Recently, I have seen more and more patients who are very frustrated and say: "I'm not going to do anything anymore". Not only has the number of syphilis cases increased, but gonorrhoea and chlamydia are also more widespread. Some people have obviously lost their desire to have sex, at least when it comes to sex in public places.
Thank you very much for the interview!
More about syphilis with transmission, treatment and protection you can find out here in the clip
or on the website of I KNOW WHAT I AM DOING
