Syphilis (Lues)

Syphilis (previously called lues) is a sexually transmitted disease (STD) that is caused by a spirochaete bacterium, Treponema pallidum.

The route of transmission is almost invariably by sexual contact; however, there are examples of direct contact infections and of congenital syphilis.

Primary syphilis is manifested after an incubation period of 10-90 days (the average is 21 days) with a primary sore. The sore, called a chancre, is localized at the point of initial exposure to the bacterium, often on the penis, vagina or rectum.

Secondary syphilis is characterized by rashlike skin lesions that appear 1-6 months after the primary infection. A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include fever, malaise, anorexia and enlarged lymph nodes.

Tertiary syphilis occurs from as early as one year after the initial infection but can take up to ten years to manifest. This stage is characterized by gummas which can occur almost anywhere in the body. Complications affecting the neurological and cardiovascular system are common in this stage.

In the United States, about 36,000 cases of syphilis are reported each year, and the actual number is presumed to be higher. About three-fifths of the reported cases occur in men.

If not treated, syphilis can cause serious effects such as damage to the nervous system, heart, or brain. Untreated syphilis can be fatal. If you think you might have syphilis, or if you find out that a sex partner had or might have had syphilis, see a doctor as soon as possible.

Syphilis can be treated with penicillin or other antibiotics.

Health care professionals suggest that safer sex practices such as the use of condoms should always be used in sexual activities, but they should by no means be considered an absolute safeguard. The best suggestion is to avoid sexual activities with anyone known to have a sexually transmissible disease, and indeed anyone whose disease-negative status you aren't certain of.

History
The origins of syphilis are not known, though it does appear to have been documented by Hippocrates in Classical Greece in its venereal/tertiary form. This form was known in a Greek city of Metaponto in Italy about 600BC, and also at Pompeii where additional archaeological evidence of uniquely grooved-teeth of the children of mothers with syphilis has been found.

Evidence of syphilis in medieval Europe has been found at the site of a 13-14th century Augustine Friar in North East English port of Kingston upon Hull.

This friary provided medical care including palliative care and burial rites for "wretched souls". The discovery at this first Augustine friary in England, which was destroyed in 1539, of skeletons carbon dated throught the friary existence bear bone lesions typical of tertiary venereal syphilis casts further doubt on the New World origin theory of syphilis.

Examination of the friary site revealed bone lesions on two/thirds of the skeletons examined, including those closest to the alter, a position reserved for richer and most generous patrons of the order.

This suggests the privileged of Hull had had syphilis for a long time. At that time, Hull was the second largest port of England after London and was a sophisticated metropolitan international port.

Another school of thought has it that syphilis was brought back to Europe from the New World by the crew of Christopher Columbus's first voyage. The evidence is weak and circumstantial, and based on the fact that the first recognized outbreak was at Naples in 1494 where a number of Spaniards from the Columbus crew participated in the army of Charles VIII of France. This theory is challenged by evidence of syphilis in the 14th century North East British port of Hull.

Because of the outbreak in the French army, it was first called morbus gallicus, or the French disease. In that time it is noteworthy that the Italians also called it the "Spanish disase", the French called it the "Italian" or "Neapolitan disease", the Russians called it the "Polish disease", and the Arabs called it the "Disease of the Christians". The name "syphilis" was first applied by Girolamo Fracastoro in 1530 from the name of a shepherd in a poem by Leonardo da Vinci.

A number of famous historical personages, beginning with Charles VIII himself, have been alleged to have had syphilis. Guy de Maupassant and Friedrich Nietzsche are both thought to have been driven insane and ultimately killed by the disease. Al Capone contracted syphilis as a young man. By the time he was incarcerated at Alcatraz, it reached its third stage, neurosyphilis, making him confused and disoriented. The painter Paul Gauguin is also said to have suffered from syphilis.

The insanity caused by late-stage syphilis was once one of the more common forms of dementia; this was known as the general paresis of the insane.

Syphilis in art and literature
There are references to syphilis in William Shakespeare's play Measure for Measure, particularly in a number of early passages spoken by the character Lucio, whose name, suggesting light and truth, is meant to indicate that he is to be taken seriously. For example Lucio says "[...] thy bones are hollow"; this is a reference to the brittleness of bones engendered by the use of mercury which was then widely used to treat syphilis.

In Charlotte Bronte's novel Jane Eyre, the character Edward Rochester's first wife, Bertha, is characterised as suffering from the advanced stages of syphilitic infection, general paresis of the insane, and there is plenty of corroborative evidence within the text to substantiate this view.

Henrik Ibsen's controversial (at the time) play Ghosts has a young man who is suffering from a mysterious unnamed disease. Though it is never named, the events of the play make it plain that this is syphilis, an inheritance from his dissolute father.

The artist Kees van Dongen produced a series of illustrations for the anarchist publication L'Assiette au Beurre showing the descent of a young prostitute from poverty to her death from syphilis as a criticism of the social order at the end of the 19th century.

Testing and treatment
Originally, there were no effective tratments for syphilis. The commonest in use were guiacum and mercury: the use of mercury gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury".

It was only in the twentieth century that effective tests and treatments for syphilis were developed.

In 1906, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of the transmission of syphilis to others, even though it did not provide a cure for those infected.

As the disease became better understood, effective treatments began to be found, beginning with the use of the arsenic-containing drug Salvarsan from 1910. One treatment that was tried was the use of malaria; the intense fever produced by a malarial attack raising the body temperature sufficiently to kill off the spirochaetes. Though this did leave the patient with a malaria infection, it was considered to be preferable to the long term effects of syphilis.

These treatements were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively cured for the first time.

In one of the more shameful episodes of the twentieth century, the Tuskegee syphilis study continued to study the lifetime course of syphilis in a group of black Americans, long after effective treatments for syphilis were available.

In the July 17, 1998 issue of the journal Science, a group of biologists reported the sequencing of the genome of T. pallidum.

People identified as probably syphilitic
Though diagnoses arrived at in retrospect from purely historical data are always open to question, it has been seriously suggested that the following figures are likely to have had syphilis:

• Idi Amin
• Al Capone
• Georges Feydeau
• Paul Gauguin
• Adolf Hitler
• King Charles VIII of France
• Christopher Columbus
• King Edward VI
• Queen Elizabeth I
• King Henry VIII and five of his wives
• Mary I of England, known as Bloody Mary
• Guy de Maupassant
• Henry Miller
• Friedrich Nietzsche
• Arthur Rimbaud
• Franz Schubert
• Robert Schumann

A limerick on syphilis
Quite a good description of how one might have suffered from syphilis back in the days before modern antibiotics. It starts out with him having a chancre; he goes on to develop secondary syphilis, losing his hair to secondary syphilis; following which he has all the common complications of tertiary syphilis before he ends up mad from neurosyphilis. The limerick also mentions his wife catching it from him and then passing it on to his children.

 
 There was a young man of Back Bay,
 Who thought syphilis just went away,  
    And felt that a chancre,  
    Was merely a canker,  
 Acquired in lascivious play.  

  
 Now first he got acne vulgaris,
 The kind that is rampant in Paris,  
    It covered his skin,  
    From forehead to shin,  
 And now people ask where his hair is.  

  
 With symptoms increasing in number,  
 His aorta's in need of a plumber,  
    His heart is cavorting,  
    His wife is aborting,  
 And now he's acquired a gumma.  

  
 Consider his terrible plight,
 His eyes won't react to the light,  
    His hands are apraxic,  
    His gait is ataxic,  
 He's developing gun-barrel sight.  

  
 His passions are strong, as before,  
 But his penis is flaccid, and sore,  
    His wife now has tabes  
    And sabre-shinned babies,
 She's really worse off than a whore.  

  
 There are pains in his belly and knees,  
 His sphincters have gone by degrees,  
    Paroxysmal incontinence,  
    With all its concomitants,  
 Brings on quite unpredictable pees.  

  
 Though treated in every known way,  
 His spirochetes grow day by day,  
    He's developed paresis,  
    Converses with Jesus,  
 And thinks he's the Queen of the May.

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