Syphilis



Syphilis (SIF-i-lis) is a sexually transmitted disease that is easily cured, but if left untreated can cause blindness, deafness, paralysis, and insanity many years after a person becomes infected.

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The Story of the Great Pox

It was 1494, not long after Christopher Columbus had returned from his first voyage to the New World. Spanish soldiers, including some of Columbus's men, were fighting the French in Italy. When the war ended and the soldiers returned home, they seemed to carry with them a terrible new illness. The Great Pox, as it was called, raged across Europe and Asia. It caused joint pain, genital sores, rashes, and wounds that gnawed away at the face, disfiguring people before it killed them after years of suffering.

The Great Pox was syphilis, scientists think, but in a more severe and contagious form than we know it today. One of the great debates of medical history is whether the men who sailed with Columbus brought syphilis back from the Americas or whether it had long been present in the Old World, perhaps confused with leprosy, and suddenly became more virulent * . The question is still unsettled.

What Is Syphilis?

Syphilis is caused by the spirochete (SPY-ro-keet) Treponema pallidum (trep-o-NEE-ma PAL-i-dum), a corkscrew-shaped type of bacteria that spreads throughout the body and can infect almost any organ. It usually is transmitted by contact with syphilitic lesions, or sores, during sexual activity, although in rare cases it can spread by nonsexual touching of a sore.

Today, syphilis is still a serious disease, but the antibiotic * penicillin (pen-i-SIL-in) can cure it easily and prevent its spread. In the United States in 1995, health officials detected 1,500 cases of syphilis in new-borns and 68,000 cases of syphilis in adults. By 1997, recently acquired infections were at the lowest levels ever reported in the United States. Health officials are especially eager to prevent syphilis because people who have syphilitic sores are more likely to become infected with HIV, the virus that causes AIDS.

Geffing Sick in Stages

The symptoms of syphilis appear in stages. The first stage, called primary syphilis, usually occurs about three weeks after infection when a sore called a chancre (SHANG-ker) appears on the body, usually in the genital area * . People often ignore the sore because it does not hurt and goes away on its own in a few weeks. Sometimes they do not notice it at all.

* virulent comes from the Latin word for poisonous, and describes a microbe that is especially adept at overcoming the body's immune system defenses.

* antibiotics (an-ly-by-OT-iks) are drugs that kill bacteria.

* The genital area is the area around the external sex organs.

The spirochete Treponemapalidum is seen under the electron microscope. © Chris Bjornberg/Photo Researchers, Inc.
The spirochete Treponemapalidum is seen under the electron microscope.
© Chris Bjornberg/Photo Researchers, Inc.

The secondary, or disseminated stage, usually starts about six weeks after infection. People feel achy, tired, and feverish. They usually have a rash that may be prominent on the palms of the hand and soles of the feet. They often lose patches of hair, giving their head a moth-eaten appearance. This bout of illness also goes away on its own. People may think they had influenza or measles, and that they are all better.

Syphilis then enters a latent, or hidden, phase. For a year or two, people may develop an occasional sore, but after that they seem healthy. In most people, the bacteria either are gone or remain inactive forever. But about one-third of infected people go on to develop late or tertiary * syphilis anywhere from 3 to 40 years after they were first infected.

Tertiary syphilis can cause problems in almost any organ. Wounds called gummas may form in the skin, bones, lungs, liver, or other internal organs and can eat away tissue in the nose or mouth, much as leprosy does. Cardiovascular syphilis (kar-dee-o-VAS-ku-lar syphilis) damages the heart or blood vessels. Neurosyphilis (NYOOR-o-sif-i-lis), which affects the nervous system, can cause headache, dizziness, and convulsions. With the most severe form of neurosyphilis, called general paresis (pa-REE-sis), people lose their memory, their reasoning ability, and their sanity. They may become blind, deaf, or paralyzed before dying.

Untreated, syphilis causes the death of 10 to 20 percent of those it infects. If a pregnant woman has untreated primary or secondary syphilis, her baby may be stillborn (dead at birth) or born already infected with syphilis (congenital syphilis). An infected baby may appear healthy at first or may have symptoms that include a rash and bloody mucus * in the nose. Later the baby may have abnormalities of the bones and teeth, mental retardation, blindness, or deafness.

As recently as the early 1930s, 60,000 children a year were born with syphilis in the United States, and as many as 20 percent of the people in American mental institutions suffered from its effects. Because of the impact it used to have on society, syphilis has been likened to AIDS, the terrible epidemic of our own age.

How Is Syphilis Diagnosed?

Syphilis can affect so many organs and resemble so many other diseases that doctors used to call it "the great impostor." Today, when doctors suspect syphilis from the symptoms, they use a microscope to look for the spirochete in fluid taken from a sore, or they can check for syphilis with blood tests.

If the syphilis spirochete is present, doctors may want to check whether the bacteria have entered the central nervous system. This requires a spinal tap, a procedure in which a needle is inserted next to the spinal cord to remove some spinal fluid for testing. Doctors usually will recommend testing for other sexually transmitted diseases including HIV, too. They also will recommend that anyone who had sex with the infected person be tested for syphilis and other sexually transmitted diseases.

* tertiary (TER-she-air-ee) means the third stage.

* mucus (MYOO-kus) is a kind of body slime. It is thick and slippery, and it lines the inside of many parts of the body. The linings that make mucus are called mucous membranes.

How Is Syphilis Treated?

The antibiotic penicillin, developed in the 1940s, revolutionized syphilis treatment. A single injection was enough to cure primary or secondary syphilis and to prevent congenital syphilis. Today, more than 50 years after the discovery of penicillin, that is still true. In latent, tertiary, and congenital syphilis, multiple doses of penicillin can eliminate the bacteria, but some internal organs may already be permanently damaged. Although penicillin is still the best medicine for syphilis, other antibiotics sometimes are used in special cases.

How Can Syphilis Be Prevented?

Syphilis can be prevented by refraining from sexual activity with an infected person. Using condoms can prevent transmission, but only if the condom covers all sores.

The Tuskegee Syphilis Study

They were poor black men, sharecroppers, mainly, who were trying to scratch out a living in Macon County, Alabama, during the Great Depression of the 1930s. Doctors from the United States government promised them free medical care if they would take part in a study of "bad blood," the local term for a number of illnesses, including anemia, diabetes, and syphilis.

Of those who agreed, 399 had syphilis. They got free medical examinations, burial insurance, and some free meals, but for 40 years (from 1932 to 1972) federal doctors knowingly let their syphilis go untreated without ever telling them that they were being denied treatment. Even after penicillin, a quick and easy cure for syphilis, was developed in the 1940s, researchers did not treat the men, but simply observed as some of the men went on to sicken and die. The doctors' goal was to understand more about syphilis by seeing how it behaves when left untreated.

The Tuskegee syphilis study ended in 1972 when newspaper stories made it public and brought a wave of revulsion from the public. In 1974 new rules were developed to protect the rights of people taking part in federally sponsored experiments. In 1997 President Bill Clinton apologized on behalf of the nation to the survivors of the most notorious medical experiment in United States history.

Issues raised by the study are still with us today. For instance, even today African Americans are less likely to get needed medical treatments, from AIDS drugs to organ transplants, than other Americans. The reasons are complicated but many researchers think racism is a factor as it was in the Tuskegee study.

Once people have been effectively treated for syphilis, they no longer can transmit the disease. If untreated, syphilis stops being contagious when lesions stop appearing, usually a year or two after the person became infected.

Paul Ehrlich and Sahachiro Hata

For centuries doctors attacked syphilis with dangerous compounds like mercury that could rot the bones. Some even infected patients with malaria in order to raise a fever and "sweat out" the disease. But early in the twentieth century, a German doctor named Paul Ehrlich (1854-1915) had a better idea.

Dr. Ehrlich, who studied the immune system, thought he could create chemical compounds that would act as "magic bullets." By this he meant that they would target the microbes that caused specific diseases without harming the rest of the body, much as the antibodies of the immune system do. Working with a Japanese colleague, Sahachiro Hata (1872—1938), Dr. Ehrlich tested hundreds of compounds against syphilis. In 1890, their six hundred and sixth experiment worked.

They had found a cure for syphilis, an arsenic compound called Salcarsan or 606.

Treatment was still quite risky, since arsenic can be a poison. But the drug marked the beginning of the modern age of medicines that have saved countless lives. One of those modern medicines, the antibiotic penicillin, later proved to be closer to a magic bullet for syphilis, often curing the dreaded disease with a single shot.

Resources

Organizations

The Centers for Disease Control and Prevention's Division of STD Prevention posts information, including a fact sheet and background on the Tuskegee syphilis study, on its website.
http://www.cdc.gov/nchstp/dstd The Centers for Disease Control and Prevention National Sexually Transmitted Diseases Hotline has counselors on hand to answer questions.
Telephone 800-227-8922

See also
Sexually Transmitted Diseases



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