Scientific Article: Syphilis

Syphilis is a sexually transmitted infection that has been around for a very long time.  As early as 1495 there are accounts of a disease that went by many different names, as it spread across Europe.  This “great pox” was often named according to the region thought to be responsible for it: “French Evil”, “Polish disease”, or “Gallic disease”.  The signs and symptoms described by the early writers match up well with what we today call syphilis.1

If left untreated, syphilis can cause serious bodily harm and even death. In about 15% of infected people, problems can develop as late as twenty years after first being exposed to the bacteria. Damage can occur to the brain, nerves, eyes, heart, blood vessels, liver, bones and joints, resulting in paralysis, blindness, dementia, and even death.2 Much of our information regarding latent and late syphilis came at a very high cost to a number of poor black American men, who were shamefully used in a human experiment in Tuskegee, Alabama.3

Although Penicillin was found to be an effective treatment for syphilis in 1943, and remains effective to this day, Syphilis has still not been eradicated. On the contrary, in the United States, the rate of primary and secondary syphilis increased by 10% from 2012 to 2013.4 Knowing the cause and knowing the cure has not stopped the spread of syphilis.  In order to avoid the consequences of the disease, focus must be placed now on prevention and early diagnosis. Diagnosis is usually made by blood tests. If a screening test for syphilis is positive, then a more specific blood test is performed.

Syphilis is transmitted from person to person by direct contact with a chancre. A chancre is a sore that appears in the primary stage of syphilis. It is usually firm, round, and painless. It is located at the place where the syphilis bacteria entered the body. There may be a single sore, or multiple ones.  Chancres may be located on the external sex organs, the vagina, the anus, the rectum, the lips or the mouth. Therefore, syphilis can be passed during sex acts that involve any of these areas. A condom that simply covers the penis or a female condom in the vagina will offer only very limited protection.  Many chancres are simply not visible and others go undetected, allowing for unknown exposure to syphilis.

The chancre will disappear even if it is not treated after three to six weeks. It is quite understandable that people can dismiss a painless sore that goes away on its own. Unfortunately, the disease does not go away with the disappearance of the chancres, but instead moves into the secondary stage. In secondary syphilis a non-itchy rash appears. The rash can vary in appearance and can mimic rashes from other causes. However, a rash or reddish-brown spots on the palms of the hands and soles of the feet are highly associated with secondary syphilis. Other symptoms may also be present, such as swollen lymph glands, fever, patchy hair loss, muscle aches and weight loss.

The next two stages of syphilis are latent and late with the designation depending on the amount of time that a person has been infected and untreated. Penicillin is still an effective treatment even in these stages. However, organs damaged by the disease remain damaged, even when the infection is cured.

Primary and Secondary (P&S) Syphilis is being found in greater numbers among younger Americans than in previous years. Twenty per cent of all new cases diagnosed are in young people, ages 15-24.5 In 2013, rates were highest among men 20 -29 years old. Men who have sex with men (MSM) accounted for 75% of all P&S syphilis cases in 2013.Black Americans account for most of P&S syphilis among individuals who are not MSM. Hispanic and other racial/ethnic minorities are also disproportionately affected.

Young people must be educated about the dangers of syphilis and other sexually transmitted infections. Testing for syphilis and other STIs needs to be performed with any change in sexual partners, or with any known sexual contact with an infected person. In high risk populations, such as MSM, testing should be performed yearly. The best way to prevent syphilis is to abstain from sexual contact, or to have sex only in a mutually monogamous relationship with a person who has been tested and is free from disease.

References:

1) John Frith, “Syphilis – Its Early History and Treatment until Penicillin and the Debate on its Origins,” Journal of Military and Veteran’s Health,Vol. 20 No. 4 (http://jmvh.org) retrieved Jan 7, 2015

2) Centers for Disease Control and Prevention, “Syphilis – CDC FactSheet,”http://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm, retrieved Jan 7, 2015

3) Allan M. Brandt, 1978. Racism and research: The case of the Tuskegee Syphilis study. The Hastings Center Report 8 (6): 21-29

4) Center for Disease Control and Prevention, “2013 Sexually Transmitted Diseases Surveillance: Syphilis” http://www.cdc.gov/std/stats13/syphilis.htm, Retrieved Jan 7, 2015

5) Centers for Disease Control and Prevention, “Sexually Transmitted Infections among Young Americans” http://www.cdc.gov/nchhstp/newsroom/docs/Youth-STI-Infographic.pdf,  Retrieved Jan 7, 2015