Syphilis: Back on the Rise and Still Deadly

syphilis

Syphilis, a sexually transmitted disease (STD) that is caused by the treponema pallidum bacteria, is easily treatable by a course of penicillin. The problem is that the disease and its progression often go undetected while the bacterium continues to damage the organs of an infected person. Before the mid-1940’s, there was no known cure for syphilis. Various treatments included the consumption of arsenic and mercury, themselves toxins, and bark from the Guamanian tree. In many instances, people died from the toxicity of the treatments instead of from the actual disease. After penicillin was introduced, the incidence of syphilis declined. As of 2012, however, the disease is back on the rise and is still deadly.

The Centers for Disease Control and Prevention (CDC) has  posted data on the incidence of syphilis and other diseases from 2008-2012. The following map shows the 30 U.S. cities where rates of syphilis are highest per 100,000 people in 2012.

syphilis

San Francisco, California, leads the nation at 117 cases per 100,000. Fulton County, Georgia, is second at 81. Baltimore, Maryland, reported 76 cases per 100,000, Washington, D.C., came in at 54, and New York County, New York, had 54 cases per 100,000. The cities with rate increases over 40 percent from 2011 to 2012 are Harris County, Texas, Multnomah County, Oregon, Bexar County, Texas, and DeKalb County, Georgia.

In March of 2013, shortly after the CDC posted its data set, PQ Monthly, published an article explaining why syphilis is back on the rise in Portland, Oregon. PQ stands for Proud Queer, and the magazine is devoted to issues that affect Portland’s LGBTQ community. Kim Toevs is program manager for Multnomah County’s STD/HIV/HCV program. Talking about the still deadly disease, Toevs told PQ that the syphilis infection rate in the county has risen by more than 1000 percent between 2008 (20 cases) and 2012 (221 cases).

syphilis

Toevs said that the local increase has been seen primarily among men who have sex with men (MSM). According to CDC data, this trend is consistent throughout the United States, where the CDC reports that 75 percent of new primary and secondary cases of syphilis occur in the MSM population. Toevs explained that, because infection comes from contact with lesions that are often buried within the vaginal canal, the rectum, or inside the mouth, the disease spreads with ease but is harder to detect. Toevs notes that the CDC data shows a strong correlation between syphilis rates and HIV infections. Public health departments around the nation emphasize testing. Getting infected people access to testing, treatment, and education about how to keep themselves and their partners safe is essential because getting treatment as soon as possible is key to the cure.

The way that syphilis damages the body is like a slow undetected water leak underneath a bathroom shower floor. By the time the floor is compromised enough from undetected dry rot that it collapses, so much damage has been done that the floor has to be ripped out, the dry rot removed, and a new shower enclosure installed. In the case of syphilis, however, the damage cannot be repaired. With early diagnosis and treatment, however, the deleterious effects of the disease can be stopped.

Syphilis is probably not on most people’s lists of things to bring home from an overseas trip, yet many famous people have done just that. Debate rages over whether syphilis existed in North and South America prior to the arrival of Christopher Columbus or whether he brought the disease with him to the undiscovered-by-Europeans world. When he returned home to Spain, the explorer died from syphilis or the complications of its treatment.

Girolamo Fracastoro  (1478-1553) was an Italian physician, poet and philosopher. During his time, common European belief was that Columbus brought syphilis back from the Americas. Fracastoro discarded the theory, believing that the disease had been extant on the European continent during classical times but had been forgotten. His theory on the spread of contagion is considered by some to be an early version of a germ theory, and he is credited with changing the medical thinking of his day. Fracastoro was first to call syphilis the French disease as recognition that French troops were spreading it.

The picture at the beginning of this article is from an engraving that was inspired by Fracastoro’s writings about syphilis. The philosopher wrote that a mythical Syphilis angered Apollo who afflicted her with a pox disease that could only be cured by the bark of a guaiacum tree. Ilceus was a mythical Syrian gardener who contracts the disease and is cured by the ingestion of mercury. While mercury may have saved the mythical Ilceus, it was not as beneficial for people who throughout history turned to it as a cure for syphilis.

Napoleon Bonaparte is also rumored to have died from complications from a syphilitic infection contracted during his European escapades, though some accounts attribute his demise to heavy metal poisoning. Ivan the Terrible, Friedrich Nietzche, Vladimir Lenin, and Al Capone are all believed to have died from the Great Pox, another common name for syphilis.

There are four stages to the syphilis infection: primary, secondary, latent, and tertiary. The list of symptoms include chancres, ulcers, lesions, maculopapular rashes, optic neuritis, syphilitic aortitis, and dementia. Incubation for the disease averages at about three weeks at which point an open sore develops at the point of initial contact. This is the primary stage. The person is infectious, but the disease is highly treatable. The lesions may last about a month to a month and  a half.

syphilis

The secondary stage of the disease often results in a whole-body rash. The lymph system is compromised, and flu-like symptoms manifest. Again symptoms usually resolve within six weeks. For 25 percent of infected people, this stage recurs. Many people who manifest at second stage did not report the lesions common to first stage.

After a period of time, the disease goes into a latent stage which can last for decades. Left untreated, 15 percent of people will develop the late stages of syphilis. By this point, the bacterium have damaged internal organs, including the nervous system, the circulatory system, the digestive organs, and the musculoskeletal system. Symptoms can present like Parkinson’s or can appear as dementia. In some late stages cases, soft tissue gummas, a soft, non-cancerous tumor, have been known to form. Though they can appear anywhere, these gummas primarily affect the skin, bones, and liver.

There is another way to contract syphilis that does not involve sexual contact. Congenital syphilis is transferred in utero from mother to child. For American women who remain untreated, the percentage of infant death is approximately 40 percent. Untreated, babies who do survive to birth may develop serious symptoms within weeks. Treatment for mothers and babies is 98 percent effective. Thanks to diagnostic tests performed during pregnancy, cases of congenital syphilis in the United States are the lowest they have ever been.

Diagnosis and treatment for syphilis are widely available, and it is unnecessary for people who fear that they are infected with syphilis to avoid medical treatment. Syphilis is a mandatory reporting illness which means that once aware of infection, health care workers are required to report the disease to local health departments. Identifying, locating, and informing former partners of infected patients allows those partners to get tested and, if necessary treated. Local health departments facilitate this notification process. For some people, however, the shame of having a sexually transmitted disease can keep them from proactively seeking treatment.

As stated above, three-quarters of new cases of syphilitic disease is showing up in the MSM population. Though the exact relationship between infection with syphilis and infection with HIV is unknown, The Lancet reports that co-infection, or the coexistence of both syphilis and HIV infections, is common in this population. Probably due to the presence of syphilitic ulcers, the transmission of HIV increases with the presence of syphilis. The article suggests that treatment of syphilis may decrease the spread of HIV. Co-infection carries additional risk because is causes syphilis to present uncharacteristically and thereby avoid early detection. With a patient who already has HIV, syphilis does not always present obvious symptoms in its primary stage. This means that patients with HIV often find they have syphilis when the disease is in its secondary, more aggressive stage.  The CDC recommends that individuals in high risk populations be tested every three months whether or not symptoms appear.

Vulnerable populations need to be ever more vigilant about regular STD testing and diagnosis. The CDC recommends that despite social stigmas against men having sex with men, it is critical that infected people speak openly with their doctors. Health departments are concerned because data shows that syphilis is back on the rise. Proactive measures to diagnose and treat the disease in vulnerable populations are underway. Though the syphilis still has the potential to be deadly, there is no reason for it to be. Treatment is simple, inexpensive, and effective.

By Kaley Perkins

Sources:
 CDC – Syphilis Data
Oregon Health Authority
CDC – Fact Sheet
New York Times
Jeffrey Sterling, MD
PQ
Wellcome Library
Encyclopedia of Renaissance and Reformation
The Lancet

One Response to "Syphilis: Back on the Rise and Still Deadly"

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