By Thomas Michael Simons, IPE
From PHN Issue 52, Spring 2023
While its origin is not completely known, the earliest evidence of syphilis was found in the Pre-Columbian Indigenous population of South America. Syphilis is caused by the Treponema pallidum spirochete bacterium, and it can cause serious health problems if not treated. It is transmitted by coming into contact with a syphilitic sore during anal, oral, or vaginal sex. These sores appear on or around the anus, penis, or vagina (they’re found in the rectum, on the lips, or in the mouth). It can be congenitally (present before birth) spread from a pregnant person to a fetus or baby.
Syphilis appeared in Naples, Italy, shortly after the return of Christopher Columbus from his first voyage to the New World. In 1494, many Spanish sailors who had sailed with him had contracted it in the West Indies, and had joined the French Army under Charles VIII for the invasion of Naples. It was then transmitted to “camp followers” as well as residents of the city (the ravages of the disease were responsible for the dispersal of the army). After the fall of Naples in 1495, the disease spread over the next 15 years. Medical histories estimate it claimed over 10 million victims during that time.
In 1910, German scientist Paul Ehrlich introduced Salvarsan (Arsphenamine, or “606”)—an arsenic compound recognized as the first drug for curing syphilis. In 1931, it was learned that it could be more effective when used with Bismuth (30 bi-monthly injections of Salvarsan interspersed with 40 injections of Bismuth). Penicillin (and later Benzathine – penicillin G) would later become the first specific cure for syphilis in 1928, but it was not widely used until 1943, by John Maloney and staff of the United States Public Health Service Hospital on Staten Island, New York. Later, tetracyclines would be used as a treatment and cure (later, oral doxycycline would be given to those having allergic reactions to penicillin regimens).
Disease progression involves 4 stages: primary, secondary, latent, and tertiary. Though it can be treated and cured at any of these stages with the proper antibiotics, syphilis can still cause permanent damage. The cure for syphilis does not protect one from reinfection. Without proper treatment, you can have syphilis in your body for years without signs or symptoms of the disease.
The primary stage generally presents with sores at or around the original infection site that may appear as firm, round, and painless. Secondary stage symptoms include a skin rash, swollen lymph nodes, and fever. The signs and symptoms of both stages can be mild and even go unnoticed. During the latent stage of infection, there are no signs or symptoms. Most with untreated syphilis do not develop the tertiary stage, but when it does present, it affects many organ systems—including blood vessels, eyes (ocular syphilis), heart, brain and nervous system (neurosyphilis). It is serious and may occur many years after initial infection. At this stage, internal organ damage and death can result.
Neurosyphilis symptoms include severe headache, difficulty in coordinating muscle movements, paralysis, numbness, and dementia (a mental disorder). Early neurosyphilis can occur at the primary and secondary stages, usually manifesting as meningitis that affects the cranial nerves and as meningovascular syphilis, which may present with stroke-like symptoms. Late neurosyphilis usually presents 10-30 years after infection and usually manifests in chronic meningoencephalitis, leading to dementia, muscle weakness, and paralysis, or tabes dorsalis (the nerves of the spinal cord lose their protective sheath). Ocular syphilis can cause vision changes such as blurred vision, eye pain, redness, and even blindness.
If you are pregnant and have syphilis, it can pass to the fetus or baby and can lead to low birth weight, premature delivery, and even stillbirth. A baby with syphilis may also be born without signs or symptoms—but if not treated immediately, the baby may develop serious health problems such as cataracts, deafness, or seizures in a few weeks, or even death.
The only way to eliminate your chance of being infected by syphilis (or any STDs/STIs) is to abstain from anal, vaginal, or oral sex.
If you are sexually active, transmission is less likely when:
- You are in a long-term, mutually monogamous relationship with a partner who has been tested for, and doesn’t have syphilis.
- You properly use condoms. It’s important to use latex condoms every time you have sex, which is why prisons should supply them, although most do not. Though condoms prevent the transmission of syphilis (by preventing contact with a sore), sometimes sores will still occur in areas not covered by the condom. Remember, contact with these sores can transmit the virus.
Anyone who is sexually active can acquire syphilis through unprotected sex. Have an earnest and open talk with your healthcare provider about getting tested, especially if you:
- Are pregnant. You should be tested at your first prenatal examination
- Are a man having sex with a man (MSM)
- Are living with HIV/AIDS
- Have a partner or partners who have tested positive for syphilis
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