Sexually Transmitted Diseases
Syphilis: A Sexual Scourge with a Long History
Syphilis is a sexually transmitted disease that begins with genital sores, progresses to a general rash, and then to disfiguring abscesses and scabs all over the body. In its late stages, untreated syphilis can cause heart abnormalities, mental disorders, blindness, other neurological problems, and death. It appeared prominently in Europe at the end of the fourteenth century, and by 1500 syphilis had spread to much of the continent. The explorer Vasco da Gama carried it to Calcutta in 1498, and by 1520 syphilis had reached Africa and China. It was considered the sexual scourge of the sixteenth century.
Al Capone, one of the most notorious gangsters of all time, contracted syphilis around 1927. After being imprisoned on Alcatraz Island, Capone's syphilis was far advanced and he was reduced to a babbling idiot despite treatment from prison doctors.
For centuries, syphilis remained a major component of the infectious disease landscape throughout Europe, Asia, and Africa. The United States has been no stranger to the disease, which most likely arrived with fifteenth- and sixteenth-century explorers. The rate of syphilis peaked in the U.S. in 1947 at 106,000 cases, but was dramatically reduced following the widespread introduction of antibiotics.
By 1996 in the United States only 11,387 cases of syphilis in its infectious stages were reported to the CDC. African Americans are 34 times more likely to be reported with syphilis than whites. In October 1999, the CDC launched a national campaign to eliminate syphilis in the United States by 2005. Since then, a steady decline in the number of people infected with syphilis reflects the positive efforts of this program.
Microbiologists Schmudinn and Hoffman in 1905 discovered and isolated the bacterium that causes syphilis. In 1906 German bacteriologist August von Wassermann, working in conjunction with Albert Neisser, discovered the Wassermann reaction, a blood-serum test that could determine if a person had syphilis. German scientist Paul Ehrlich, in 1908, began his research to find a better drug to fight the disease by testing hundreds of different arsenic compounds on syphilitic rats. One compound was found that effectively destroyed syphilis without destroying the rat. He called it Salvarsan, which in English means “I save.”
Treponema pallidum is the bacterium that causes syphilis. Syphilis can move throughout the body, damaging many organs over time. After initial penetration, the bacteria enter the lymph capillaries, where they are transported to the nearest lymph gland. There, they multiply and are released into the bloodstream, where they invade every part of the body.
How Syphilis Is Spread (Watch Out for Sores!)
In acquired syphilis, the bacterium enters the body through skin or mucous membranes, usually during sexual contact. It can be spread from the sores of an infected person to the mucous membranes of the genital area, the mouth, or the anus of a sexual partner. The bacteria are very fragile, and the infection is not spread by contact with objects such as toilet seats or towels.
Congenital syphilis occurs when a pregnant woman with syphilis passes the bacteria through the placenta to her unborn child. People at risk for syphilis, like other STDs, are those who have had multiple sex partners and engage in high-risk sexual practices. An infected person who does not get treatment may infect others during the first two stages of the disease (see the next section) when sores are present.
Syphilis is characterized by four prominent stages: primary, secondary, latent, and tertiary (also called the late stage). The primary stage is marked by the appearance of a sore, called a chancre, which usually occurs 10 to 21 days following exposure but may take up to three months to appear. The chancre is generally found on the penis, vagina, or rectum but may also develop on the cervix, tongue, lips, or other parts of the body. It is usually painless and disappears within a few weeks regardless of whether or not it is treated.
Syphilis can invade the nervous system, causing neuro-syphilis, which may result in headaches, stiff neck, and fever from inflammation of the lining of the brain. Neurosyphilis may cause paralysis and insanity, as well as a degeneration of the spinal cord, causing a stumbling, foot-stamping gait.
Secondary syphilis is distinguished by a skin rash that appears up to 10 weeks after the chancre heals. The rash, resembling measles or chickenpox, may cover the whole body or appear only in a few areas, such as on the palms of the hands or soles of the feet. Fever, indigestion, or headaches may accompany the rash. The rash usually heals within several weeks or months. In some cases, ulcers may appear in the mouth. Scalp hair may drop out in patches, creating a “moth-eaten” appearance. Other symptoms include mild fever, fatigue, headache, sore throat, and swollen lymph glands. Pain in bones and joints and heart palpitations may develop. However, the symptoms, which generally tend to be mild, disappear without treatment but may reoccur over the next two years.
Next, the disease goes into a latent or hidden stage when it is difficult to detect the bacteria even with tests. If left untreated during the latent stage, 50 to 70 percent of people who carry the disease suffer no further consequences. However, approximately one third of those infected develop complications of late, or tertiary, syphilis in which the bacteria damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. This stage can last for years, or even decades. Late syphilis is the feared stage, because it can result in mental illness, blindness, other neurological problems, heart disease, and death.
Congenital Syphilis: Infection During Pregnancy
A pregnant woman with active untreated syphilis will pass the infection to her unborn child. Up to 70 percent of such pregnancies will result in a syphilitic infant. Most babies develop symptoms such as skin sores, rashes, fever, weakened crying, swollen liver and spleen, jaundice (yellowish skin), anemia, and various deformities between two weeks and three months after birth. Sometimes the symptoms of syphilis don't appear for many years, and older children may develop symptoms of late congenital syphilis, including damage to their bones, teeth, sight, hearing, and brain.
Diagnosing “the Great Imitator”
In 1932, the United States Public Health Service, in cooperation with the Tuskegee Institute, initiated a study in Macon County, Alabama, to determine the effects of untreated syphilis. From 1932 through 1972, 399 low-income African American men with latent syphilis went untreated for the disease after being offered “so-called” free medical care. The men, the most educated of whom completed seventh grade, were told they were being treated for an ongoing condition of “bad blood.” They were never told that they were part of a study, nor were they informed that they had syphilis. Government doctors failed to offer standard treatments, nor did they offer penicillin once it became the standard method of curing the disease. The study was stopped in 1970 only after its existence was leaked to the public. By that time, at least 28, and perhaps as many as 100, men had died as a direct result of complications caused by syphilis.
The surviving men received treatment only after the experiment became public. In December of 1974, the government agreed to pay approximately $10 million in an out-of-court settlement: $37,500 per participant. The lessons learned from this “holocaust era” experiment formed the basis for current-day human subjects research guidelines. On May 16, 1997, the surviving participants of the Tuskegee Syphilis Study gathered at the White House and witnessed President Clinton's long overdue apology on behalf of the United States government.
Syphilis has sometimes been called “the great imitator” because its early symptoms resemble those of many other diseases. People who have more than one sex partner should consult a physician about any suspicious rash or sore in the genital area. Individuals who have been treated for another STD, such as gonorrhea, should be tested for syphilis.
Syphilis can be diagnosed by evaluating a combination of clinical signs and symptoms, direct microscopic observation in tissue or blood, and antibody-based blood tests. The principal screening tests for syphilis are the VDRL (Venereal Disease Research Laboratory) and RPR (rapid plasma regain) tests, which detect a rise in antibody following infection. The later the stage of infection, the greater the ability of the tests to detect antibodies.
While blood tests can provide evidence of infection, they may give false negative results for up to three months after infection. In addition, blood tests for syphilis can sometimes be positive even though a person isn't infected with the disease. Interpretation of blood tests for syphilis can be difficult, and repeated tests are sometimes necessary to confirm the diagnosis.
With Proper Treatment, There Is a Cure
At one time, mercury was given to people suffering from syphilis, but it probably poisoned more people than it helped. Today, syphilis is treated with penicillin. Other antibiotics, such as tetracycline, can be used for patients allergic to penicillin. It is important that people being treated for syphilis have periodic blood tests to ensure that they have been cured.
Individuals with syphilis that has invaded the nervous system may need to be retested for up to two years after treatment. Fortunately, proper treatment will cure the disease in all stages.
The Best Protection
Not having sex is the best protection against acquiring syphilis and other STDs. Open sores associated with syphilis may be visible and are infectious during the active stages of the disease. Any contact with these infectious sores must be avoided to prevent the spread of the disease. Latex condoms can reduce the risk of syphilis; however, lesions may occur in areas that cannot be covered or protected by a condom. Testing and treatment early in pregnancy is the best way to prevent syphilis in infants.
There is no vaccine for syphilis, no acquired immunity to syphilis, and past infection provides no protection! A person can be infected with syphilis, treated, and then become reinfected, once, twice, or a hundred times.