An increase in the rise of syphilis infections in Serbia is just one of the worrying pieces of information we have come across in the last few weeks. Data collected by the Dr. Milan Jovanović Batut Institute of Public Health of Serbia, published in mid-January, suggests what we could have guessed: Covid hindered proper monitoring of syphilis cases. Because of this, there is now the highest registered case rate in the past 10 years.

As the report states, out of 238 registered cases in Serbia, the biggest number (129) was recorded in Belgrade, 124 of which were men, “with the assumption that share of the registered cases among men who have sexual intercourse with men (MSM) is the same as it was in 2019 and 2020.”

Although the report doesn’t go further than these assumptions, and though I can’t assume that anyone would even read the report except to check some date — which must be compared to other relevant reports by European institutes and organizations — I will allow myself to write the rest of this article as a series of assumptions.

Poetry, punishment and clickbait

But before that, let’s review a few facts that go beyond assumptions. Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum. Until the development of penicillin and its wide usage, syphilis was an incurable disease. 

What makes syphilis so sinister is the fact that it can go unnoticed. Because of that, the bacterial infection can linger for a long time before it is diagnosed and treated.

The bacteria is transmitted by direct contact with mucous membranes or infected fluids from open or hidden skin lesions, as well as bodily fluids of an infected person during sexual intercourse. Also, it is possible for the bacteria to be transmitted from the mother to the child via the placenta or during birth. Infection through blood transfusion is possible if the blood donor is in the latent stage of the disease.

The disease’s name was coined by the 16th-century Italian poet Girolamo Fracastoro in his poem, where a young shepherd Syphilis is punished by an illness sent by none other than Apollo himself. Throughout the history of the disease, it has been perceived as punishment for (sexual) transgressions.

On the other hand, the disease is romanticized to this day because media outlets point out the fact that many artists suffered from syphilis (so what?).

Since the release of the data on the increase of infected individuals in Serbia, the media has fallen into the well-known pattern of producing clickable headlines — epidemiologists shocked by the reappearance of a non-eradicated disease, Serbian society labeled as syphilis-infested and so on. 

They place blame for the whole problem on individuals’ moral inclinations. Encouraged by dating apps and the desire for instant gratification, the individual fails to ponder the health of the community, doesn’t fight to free the homeland, etc. Although we could discuss the role of individuals’ moral responsibility — above all, toward one’s own health — the whole problem of the syphilis’s reemergence doesn’t rest there.

Semi-outed

In light of the recent report and the media articles that followed, let me give a rundown of how things actually go. Let’s say that seven days after the news about the rise in syphilis infections, you receive a message from a former partner: I have syphilis, get tested.

To set the scene, let’s assume you are, just like the author of this piece, a middle-aged homosexual, semi-outed, with mediocre pay for one full-time and several part-time jobs, for which his performance is mediocre. Let’s also assume that your concern for your health is limited to sporadic doctor’s checkups, with examinations on reproductive health coming only later, after your awareness, and then fear, about STIs developed and created chaos in your already chaotic life.

Following the initial shock and disbelief, the vicious circle of self-pity, post-coital abstinence (“no way I’m having sex anymore”), then broken confidence that nothing could happen to you, followed by a mental collapse that makes you only see worst-case scenarios, for the first few days your mental haze creates a void.

After a few more days, you start to Google “syphilis disease and treatment.” Google explodes with explicit information and even more explicit photos that you stare at for hours. You start to inspect your body because you just learned that a rash can be one of the signs of syphilis.

It doesn’t take you long to spot a red dot below your navel. It doesn’t hurt when you touch it, but it sure is big and red. Although you’ve seen it many times before, and it’s probably just an ingrown hair or pimple — surely nothing dangerous — your brain does everything to convince you that it is a syphilitic lesion, a visible trace of your errors.

Drama queen

All of a sudden, you remember that you can never donate blood again, although you have yet. You consider telling everything to a friend who won’t judge or ridicule you — because who has syphilis these days, really? In the end, you decide to keep quiet because why start some drama and explain what you were doing with your ex and why you didn’t use protection?

It doesn’t even cross your mind to visit the health center or the infectious disease department because your sisters work there, and you don’t want them learning from your digital health record anything that could reveal your sexual history (outing yourself to your family is one thing, but it’s something completely different if you have to admit to a disease resulting from your sexual practices).

You don’t visit local organizations working to prevent STIs because somebody might recognize you — you even convince yourself they would judge you. You pick out a laboratory close to your apartment which, as you thankfully notice, has a discount on testing for STIs. It’s the same place your ex got tested. He can’t understand what you are waiting for since they are extremely discrete.

For now, you avoid thinking about what could happen if you have syphilis. You make an appointment and go in to have your blood drawn by a relatively cute medical technician (because you are bored, you open up Grindr to check if anybody is nearby; you realize there are no relatively cute technicians on the platform). He asks you several questions. You tell him that your partner told you that he has syphilis and that you need to get tested. You wait for a look that screams prejudice and curiosity, but it doesn’t come.

The technician draws your blood quickly, says that you will get the results via email in the next two or three days, and you leave the place seemingly relieved because at least you have started the process and taken control. You still don’t want to think about what will happen if you have syphilis, but these terrible thoughts are outweighed by the data you found online. You think of doctor friends who can surely give you penicillin if you test positive — no one needs to find out about your secret.

Euphoric release

You finally get your results after five days of anticipation interspersed with bursts of religiosity (please God, just not this time), hanging out on Grindr due to depressive boredom (what are you into? — not much, just skimming) and two miswritten email addresses because you have a ridiculous last name that no one has ever managed to pronounce or write properly.

Treponema pallidum isn’t present in your body, and, at least for now, you are safe.

With a burst of euphoria and the happiness of being alive — even though people don’t die from syphilis these days, at least not that easily — you feel that you have saved yourself and that this is your chance to start over. You go out for a walk, you treat yourself, you buy a big ice cream, who cares, but then as an afterthought, unwanted fears rush in.

Because, during all this you were on your own. Everything is in order now, but what will you do when you grow old and there is nobody there to tell or complain to?

You realize how much your internalized homophobia is destroying you from within, that it may be a disease you’ll never be cured of, and that there is no data or relevant institutions in our society about it. Think about what happens to those assumed 124 men who have sex with other men, whether they also go through all this alone, and how many of them will cope with both syphilis and internalized homophobia.

You can imagine a whole collection of stories that would depict syphilis from the perspective of class and gender, but the point of the collection of stories would certainly be that it’s a disease that few deal with or work to treat — although it has ruined so many lives.

Some things are (in)curable

Imagine how many gay people have died from homophobia, how many lives were based on lies and eternal conformity that stopped people from standing out. Imagine how many marriages have been destroyed. Imagine how many of them had to deal with this and other diseases only because somewhere deep inside, they believed that they didn’t deserve better, that because of who they are, they should hide everything about themselves, especially the status of their health.

And when you wrap your head around all those unhappy people, all those wasted lives, where diseases (including sexual ones) are just one part of their existence, you will understand that syphilis has not broken out in Serbia and other countries, nor is an epidemic of it threatening us. The disease that has plagued almost all societies in the Balkans for years is actually homophobia. And for now there is no way to efficiently suppress this disease, either by prevention or by discovering a unique cure for hatred toward the other.

In a new institute, which would be solely concerned with researching homophobia, instead of faulty assumptions, scientists could work to develop a cure targeting individuals who have internalized homophobia, who find themselves threatened by self-loathing and (self-)destructive behavior. 

Along with that, if in some imaginary society kids had some sort of sex education in schools starting from puberty, perhaps we would avoid syphilis reemerging in 2023 as some sort of forgotten disease, just like we could hope that homophobia would be an almost forgotten disease. 

In this case, this article would not exist, all these assumptions would be superfluous. However, when the institutions that should take care of both the health of the individual and the health of the community go into the realm of assumptions, you can assume that you’ll be left to your own devices.

Maybe you will catch syphilis someday, but trust me, it’s homophobia that’s going to kill us all, sooner or later.

Feature image:  Igor Čoko.