How to Prevent Syphilis

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With no vaccine to prevent infection, safer sex remains the single best way to avoid getting syphilis. This is especially true if you are or intend to get pregnant. While congenital syphilis (syphilis passed from mother to child during pregnancy) is still relatively uncommon in the United States, the rate of infection increased by nearly 800 percent between 2015 and 2016 alone, according to statistics from the Centers for Disease Control and Prevention (CDC).

Safer Sex

Unprotected sex and multiple sex partners are the two primary risk factors for getting syphilis and other sexually transmitted infections/diseases (STIs/STDs). Safer sex, therefore, involves two simple things: the consistent use of condoms and a concerted reduction in your number of sex partners.

Condoms

Condoms are considered the first-line defense against all sexually transmitted infections. While they are fallible—especially if you don't use them correctly—they remain the most reliable form of prevention short of abstinence. Avoid novelty or flavored condoms, which are not designed to prevent STDs, and learn how to size a condom correctly to prevent it from breaking or slipping off. Use only water-based lubricants; others can degrade condoms.

Dental dams should also be considered for oral-vaginal sex (cunnilingus) or oral-anal sex (analingus, or "rimming"). Female condoms, largely ignored in the United States, also have their place.

As an added safeguard, use condoms on shared sex toys and be sure to disinfect toys between uses.

Sex Partners

Equally important is a reduction in your number of sex partners, particularly those who are anonymous or who you meet online. In the end, the more people you have sex with, the greater your odds of getting not only syphilis but other STDs for which condoms are less effective, such as the human papillomavirus (HPV).

If you meet someone new, it is in your best interest to negotiate the rules for safer sex in advance of hooking up. As awkward as it may be, try not to leave things unspoken or wonder who was supposed to get the condoms. If your partner is unwilling or reluctant to use condoms, you will at least have the information needed to make an informed choice.

You should also make a point of asking about your partner's sexual history and whether he or she has ever been tested for STDs. You can usually open the conversation by revealing your status first. Doing so may even encourage your partner to follow your lead and get tested, too.

Finally, when you do have sex, avoid using drugs or alcohol, which can impair your judgment and lead to sexual disinhibition.

Screening Recommendations

The best way to reverse the tide of new infections is to ensure that anyone who is at risk of syphilis and other STDs is properly screened. The tests are quick and easy to perform, and they can be conducted confidentially at a clinic, lab, and many retail pharmacies. At-home or mail-in tests are also available.

Testing sites (including low-cost and no-cost public clinics) can be found through the CDC's online locator.

In 2016, the U.S. Preventive Services Task Force (USPSTF) issued updated guidelines on the screening of STDs in the following risk groups:

  • Screen for chlamydia and gonorrhea in sexually active women age 24 and under, as well as older women at an increased risk of infection
  • Screen for syphilis, hepatitis B, and HIV in all pregnant women (more on this below)
  • Screen for HIV in all people 15 to 65 as part of a routine doctor visit
  • Screen for syphilis, HIV, and hepatitis B in any person at an increased risk

According to the USPSTF, persons at increased risk include those who have more than one sex partner, a new sex partner, or a sex partner with concurrent partners, or those who are not in a mutually monogamous relationship and use condoms inconsistently.

Injecting drug users and sexually active men who have sex with men (MSM) who have anonymous or multiple partners may need to be tested annually.

Pregnant Women

Congenital syphilis is entirely preventable if diagnosed early. The CDC recommends that all pregnant women be screened for syphilis at their first prenatal visit. Those who are at increased or ongoing risk of exposure should be tested again at 28 weeks. Any positive result would be immediately treated with penicillin, the only antibiotic known to prevent transmission of syphilis to the baby.

Your partner should also be tested, particularly if he or she has never done so. This way, if there is an STD present, he or she can be diagnosed and treated early. Protection should always be used if there is any chance of infection.

Sources:

Centers for Disease Control and Prevention (CDC). "2016 Sexually Transmitted Diseases Surveillance: Syphilis." Atlanta, Georgia; updated September 26, 2017.

CDC. "2015 Sexually Transmitted Diseases Guidelines: Congenital Syphilis." Issued June 4, 2015.

Lee, K.; Nyo-Metzger, Q.; Wolff, T. et al. "Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force." American Family Physician. 2016; 94(11):907-915.