Syphillis

• Syphilis has many alternate names, including: "The Great Pox", "Lues", "Syph", "The Pox"
• Four Stages of Syphilis

  1. Primary Stage
  2. Secondary Stage
  3. Latent (third) stage
  4. Tertiary (late) Stage
• Primary Stage of Syphilis


  • Bacterium acquired via direct sexual contact with the infectious lesions of a person with syphilis
  • Approximately 10-90 days after the initial exposure, a skin lesion may be seen on the genitalia
  • This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina or rectum or lip
  • The lesion may persist for 4 to 6 weeks and usually heals spontaneously
• Secondary Syphilis


  • Occurs approximately 1-6 months after the primary infection
  • There may be a symmetrical reddish-pink non-itchy rash on the body trunk and extremities
  • In moist areas of the body, the rash becomes flat broad whitish lesions known as "condylomata lata"
  • All of these lesions are infectious and harbor active spirochete bacteria
  • Other symptoms common at this stage include fever, sore throat, malaise, weight loss, headache, stiff neck, meningitis, and enlarged lymph nodes
• Tertiary (late) Syphilis


  • Enlarged lymph nodes
  • Gummatous (granulomatous) syphilis
  • Neurosyphilis (brain and spinal cord damage)
  • Meningovascular
  • General paresis
  • Spinal cord damage
  • Cardiovascular syphilis
  • Aortic aneurysms
• Syphilis


  • The name "Syphilis" was coined by the Italian physician and poet Girolamo Fracastoro from Verona, Italy
  • In his epic poem, Syphilus Sive Morbus Gallicus, written in Latin, he tells of a young shepherd boy named Syphilis who insulted the Greek god Apollo and was inflicted with a horrible disease as punishment
  • Franastoro described the disease syphilis and he blamed it on introduction to Naples by soldiers in the army of King Charles VIII of France
• Xenophobic Names for Syphilis


  • "French disease" in Italy and Germany
  • "Italian disease" in France
  • "Spanish disease" in the Netherlands
  • "Polish disease" in Russia
  • "Christian disease" in Turkey
  • "British disease" in Tahiti
• Great "Syphilitics" of History (Famous People who had Syphilis)


  • Christopher Columbus
  • Pope Alexander VI Borges Family
  • Ivan the Terrible
  • Henry VIII of England
  • Hernán Cortés
  • Francis I of France
  • Meriwether Lewis
  • Abraham Lincoln
  • William Shakespeare
  • Vladimir Lenin
  • Adopt Hitler
  • Toulouse Lautrec
  • Paul Gauguin
  • Randolph Churchill
  • Al Capone
  • Karen Blixen
  • Idi Amin
• Theories of the Origin of Syphilis

  • The Columbian (New World) Theory
  • The Old World Theory
• The Columbian Exchange Theory

  • Syphilis is brought to Europe from the Americas
  • Perhaps it was a more virulent form of Syphilis
  • Lesions on pre-European contact Native Americans
  • Recent genetic evidence suggests all syphilis in Europe had a common origin around 1500
• The Old World Theory

  • Syphilis most likely existed prior to 1490s in Europe but was unrecognized, confused with other diseases such as leprosy, or less virulent forms were circulating
  • Urbanization, rising promiscuity of the times, social turmoil and wars, created unique conditions suitable for its emergence as an epidemic
  • Syphilis symptoms described by Hippocrates
  • Skeletons with lesions from Pompeii
• Systematic Attempts to Distinguish Venereal Diseases:

  • Gonorrhea was recognized as a venereal disease in 13th and 14th centuries
  • 1496, Joseph Grunpeck clearly described mixed infections of syphilis and gonorrhea
  • 1530, Paracelsus declared gonorrhea an early stage of syphilis
• In 1767, John Hunter inoculated himself with pus from a patient with gonorrhea and died of syphilitic heart disease in 1793
• In 1793, Benjamin Bell experimented on himself and medical students and demonstrated that syphilis and gonorrhea were distinct
• Early 1900 advances in knowledge about syphilis. 3 major breakthroughs:

  • The Spirochete, Treponema pallidum identified
  • Serologic diagnostic test for syphilis developed
  • Advances in therapy i.e. treatment
• Treponema pallidum Identified

  • 1903: Metchnikoff and Roux transmitted infection to monkeys, making possible experimental studies
  • 1905: Schaudinn and Hoffmann found spirochete in serum of a patient with secondary syphilis
  • 1906: Reuter found spirochete in wall of syphilitic aorta
• Serologic diagnostic test for syphilis developed in early 1900's

  • 1906: August von Wassermann reported complement fixation test of patients' serum, detecting antibodies against T. pallidum
  • Allowed detection of millions of previously undiagnosed people
  • Syphilis is a reportable disease!
• Diagnostic Tests for Syphilis

  • Dark field microscopy
  • Antibody tests: Complement Fixation test, Fluorescent Antibody, ELISA
  • Nucleic Acid Test, Polymerase Chain Reaction Test (PCR)
• Syphilis was accepted as disobedience to the laws of religion and morality, and those who suffered received their justice
• • From the onset of the epidemic, arrest and quarantine of infected persons, prostitutes, foreigners and other high-risk persons was practiced
  • Prostitution was often outlawed and prostitutes were subjected to persecution
• Syphilis is on the rise in the United States
• Vaugirard Hospital, Paris

  Dedicated to the therapy of congenital syphilis. Pregnant syphilitic women were brought from other public institutions, treated with mercury, and then served as wet-nurses to newborns. Designed to safely and efficiently deliver state of the art care (i.e., mercury) to treat infants. Marked the first attempt by a government to deal with syphilis as a demographic and medical problem, rather than moral or religious
• The Oslo study (1890-1910)

  • N=1,404
  • Autopsies on people showed 24% positive
  • Tertiary stage syphilis 28%
  • Symptomatic neurosyphilis 10% Male; 5% female
  • Cardiovascular symptoms 13%
• Public Health In Early 19th Century

  • Public campaigns promoting abstinence and marriage, including morality plays
  • France: Registering prostitutes; official brothels; special hospitals
  • England: Mandatory physical exams of suspected prostitutes
  • New interest groups begin to challenge these approaches
• • Breakthroughs of early 20th century made prospects of national disease control and eradication possible
  • World War I brought the issue of this important venereal diseases to a top priority for the military
• Guaiacum Wood Treatment

  Wood called Guaiacum came from the Americas. Grind the wood, boil in water, drink. Guaiacum was hung in churches, homes, etc., as objects of veneration
• Mercury Therapy


  Earliest therapy against syphilis. Long tradition in Arab medicine as therapy for a wide range of skin afflictions. Remained the most generally widespread therapy through the 19th century (1800's). It produced copious saliva, thereby "expelling phlegm". This is a classic sign of mercury poisoning
• Fever Therapy


  Julius Von Wagner-Jauregg; Austrian Physician. Malarial therapy—1917. Inject 5-10 cc of serum from patients infected with malaria parasite, Plasmodium vivax. Allow 10-12 bouts of fever to 103-106, each of 6-12 hour duration. Give quinine to break the malaria fever. 20-30% of the patients went into complete remission. 1927 Nobel Prize in Medicine
• Dr Paul Ehrlich


  In 1906, prophesied the role of modern-day pharmaceutical research, predicting that chemists in their laboratories would soon be able to produce substances that would seek out specific disease-causing agents. Received the Nobel Prize in Physiology or Medicine in 1908 for his work on syphlis
• Arsphenamine


  • First effective treatment developed by Sahachirō Hata in the laboratory of Paul Ehrlich.
  • 1909. A form of Arsenic. Heavy metals could cure some acute infections, but were not effective versus later infections, especially neurosyphilis.
  • Replaced mercury, long treatment and very toxic.
• Alexander Fleming, Howard Florey, Ernest Chain


  Inventors of Penicillin
• Sir Alexander Fleming


  Knighted and is the one everyone remembers. Nobel Prize in Medicine 1945
• John F. Mahoney, 1943


  Treated four patients with primary syphilis and reported remarkable responses. Treated men returning from World War II with penicillin
• • Venereal disease was the major cause of rejection of prospective recruits for the US Army. Rates of syphilis in American and European Armies exceeded 10% during World War I!
  • No education or condoms provided.
  • Lost salary if you contracted a venereal disease and it was discovered. i.e. punished for your behavior
• 1918: "VD Division" of the US Public Health Service (USPHS) established, but war ends and interest in syphilis control waned
• Dr. Thomas Parran

  Appointed Surgeon General of the US in 1938 until 1968. His effort to eradicate syphilis in the army using 5 point plan:

  1. Identify the cases,
  2. Treat infected cases,
  3. Break the chain of transmission,
  4. Mandatory premarital testing,
  5. Education
• 170,000 infected US servicemen are treated prior to be placed on active duty during World War II
• 1943: Government creates rapid treatment centers that provide 5-10 days of continuous infusion arsenic compound therapy
• 1944-1946: At the end of WW II, over 50,000 US servicemen are treated with penicillin prior to discharge
• Marriage Licenses in 26 states required testing

  Historically, many states have required applicants for a marriage license to obtain a blood test for venereal diseases (most commonly syphilis and later gonorrhea). These tests were part of a broad public health campaign enacted in the late 1930s by U.S. Surgeon General Thomas Parran to inform the potential marriage partner of the risk of contracting a communicable disease, and to reduce the risk of birth defects associated with syphilis