Coming clean before and after sex

Dear Dr. G,

I met my husband last year, at the time aged 38. I am aware of him being divorced three years ago after the failure of his previous marriage.

Apart from his relationship with his ex-wife, I really do not ask him too much about his other past sexual relationships.

We have a very active sexual intimacy even before we were married.

Obviously, we trust each other completely and do not use condoms.

I was shocked when I recently found out my husband had been through a medical check up for his work, that he suffers from syphilis.

His blood tests showed he is TPHA positive, I did a google search and I feel very hurt, as my husband did not disclose his history of sexually transmitted disease.

I am also very worried as I am now three months pregnant. I am seriously worried how the infection can affect my baby and I.

Can you please tell me what exactly is syphilis?

Isn’t it true that syphilis has been long eradicated?

How should I get tested and treated for this infection?

And how should I confront my husband for not coming clean about his past sexually transmitted infections that now affect me?

Regards
Infected Ingrid

Syphilis is a sexually transmitted infection caused by a bacterium called Treponema pallidum. This infection was termed the “Great Pox” from the New World as the record of syphilis was not documented prior to the 15th century. The Columbian Hypothesis stipulated the disease may have been carried from the Americas to Europe by the returning crewmen from Christopher Columbus’s voyage. The first written outbreak of syphilis was in Naples in 1494, during the French invasion of Italy. The Italian labelled the infection as the “French Disease”, while the French called it the “Neapolitan Disease”. As the disease spread further afield, the Dutch called it the “Spanish pocks” and the Turks named it the “Christian Disease”.

Even up the 19th century, syphilis was one of the largest public health burdens, as more than 20% of individuals aged 15-34 years in London were treated for the infection. The spread of syphilis declined rapidly with the widespread use of antibiotics since the early 20th century. Contrary to common belief, syphilis is not eradicated as the prevalence has increased since 2000. In 2015, about 45 million people were infected with syphilis, with six million new cases per annum. Left untreated, the infection has a mortality rate of 8% to 58%, reflecting the annual mortality of 107,000 deaths in 2015.

Syphilis is also known as the “great imitator” as it may cause symptoms mimicking many other diseases, in different stages and manifestations. The primary stage usually appears six weeks after initial contact, classically presents with a single painless firm ulceration in the genitalia called chancre. Secondary syphilis occurs approximately ten weeks after contraction, resulting in diffuse rash involving the mouth, genitalia, palms of hands and soles of the feet. The latent stages occur two years after the infection which lasts for years. Without treatment, approximately 15-40% of infected individuals develop tertiary syphilis,

occurring even after 15 years. The final stage syphilis can result in neuro and cardiovascular syphilis, which may be fatal. Syphilis is contagious during primary and secondary stages, and sometimes in the early latent period.

This sexually transmitted infection is typically spread from skin or mucosa, through sexual contacts. The genital sores associated with syphilis can also increase the risk of transmission of HIV. Early syphilis is curable by penicillin injections. Without treatment, syphilis can result in severe damage to other organs outside the genitals, such as the heart and brain. This may result in stroke, meningitis, deafness and even dementia. Syphilis may also pass from an infected mother to an unborn baby. Congenital syphilis can increase the risk of miscarriage and stillbirths.

Blood tests are usually carried out to determine one’s infection status. This confirms the presence of antibodies that were produced to fight the bacteria. However, false-positive tests for syphilis are common, which may occur in the presence of viral infections such as chickenpox and measles. False-positive also occurs in non-infectious conditions such as TB, malaria and even pregnancy. The antibodies to the bacteria often remain in the body for years, reminding the sufferers of the secret past, despite being infection-free. The presence of TPHA in the blood test, and the absence of VDRL is likely to represent this past infection rather than current active syphilis. Therefore, the initial positive screening tests may require further verification with detailed confirmatory investigations.

Nelson Mandela once said: “To deny people their human rights is to challenge their very humanity.” When it comes to sex, there are often two sides to the story. On one hand, the right to privacy and on the other, self-protection. In a relationship, the non-disclosure of the past sexual history may not necessarily done with ill intent, but often out of love. Therefore, open communications of the couple coming clean before sex and marriage is the most appropriate way. Obviously, when it comes to the revulsion and taboo subjects of syphilis, open discussion is easier said than done. Individuals troubled by a potential sexual infection transmitted by partners who are not coming clean is putting Dr. G on the spot for advice. With syphilis tests having the potential false positivity and disease being completely curable, he reckons “It’s never too late to have a right to come clean even after sex!”.