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Cupid’s Disease
A brief
historical
insight
into
Syphilis
“lover of swine”
The many identities of Syphilis…
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Syph
Cupid’s disease
The Pox, Great Pox, or German Pox
The French, Spanish, English, Italian,
Portuguese, or Neapolitan disease
The Polish illness or Castilian infection
The disease of the Christians
Origins
Two main theories:
1. PRE - COLUMBIAN
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Syphilis was described by Hippocrates in its tertiary
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It is believed to be referred to in the bible many times;
including Exodus 20:5 -
form
“the sins of the father passed down to his son’s,
and their son’s…”
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Reported at a 13th-14th century Augustinian Friary in
the English port of Kingston upon Hull
Origins
2.
COLUMBIAN EXCHANGE THEORY
Syphilis was a New World
disease brought back by
Christopher Columbus.
The first well-documented
outbreak of syphilis occurred in
Naples in 1494, with evidence
connecting Columbus’s crew to
the outbreak.
In Reality…
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The epidemiology of the first syphilis epidemic
indicates it was either a new or mutated form of
an earlier disease.
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The early form was much more virulent than
the disease of today. With a shorter incubation
period (only a few months), the symptoms were
much more severe and more frequently fatal.
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By 1546 the disease had evolved into the form
we know today.
Syphilis of the Rich and Famous
Henry VIII
Ivan the Terrible
Syphilis of the Rich and Famous
Paul Gauguin
Al Capone
Stages of Syphilis
PRIMARY
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Typically acquired via direct sexual contact with
infectious lesions.
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Manifests after an incubation period of 10-90 days with a
primary sore or chancre.
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Patients are typically asymptomatic during the initial
incubation period
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The chancre is a firm, painless skin ulceration localised
at the point of initial exposure to the bacterium.
Most commonly on the penis, vagina or rectum.
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Lesions persist for 4-6 weeks, after which they heal.
Chancre on the Tongue
SECONDARY SYPHILIS
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Characterised by a skin rash, appearing 1- 6 months
after primary infection. Most commonly a reddish-pink
non-itchy rash on the trunk and extremities, frequently
involving the palms of the hands and soles of the feet.
Mucous patches may also appear on the mouth or
genitals.
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Other symptoms may include fever, sore throat, malaise,
weight loss, meninigmus, and headache.
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This is the most contagious stage.
Typical presentation of secondary syphilis
rash on the palms of the hands
TERTIARY SYPHILIS
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Occurs as early as 1 year after initial infection,
but can take up to 10.
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Characterised by the formation of gummas; soft
tumour-like growths readily seen in the skin and
mucous membranes. They can occur almost
anywhere in the body including the skeleton,
affecting joints.
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More severe manifestations include neurosyphilis
and cardiovascular syphilis.
Gummas
LATENT SYPHILIS
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defined as having serological proof of infection
without signs or symptoms of disease
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can be early (2 years or less from initial infection)
or late (infection >2 years without clinical evidence
of disease)
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distinction between the two is important in terms
of therapy and risk of transmission
Diagnostic Tests
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1906 – the first effective
test for syphilis was
developed, the
Wassermann test.
Produced some false
positives but still a major
advancement.
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1930’s – the Hinton
flocculation test was
developed; producing
fewer false positives.
Diagnostic Tests
More recently used screening methods include:
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Rapid Plasma Reagin (RPR)
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Venereal Disease Research Laboratory (VDRL)
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Treponema Pallidum Haemaglutination Assay (TPHA)
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Fluorescent antibody absorption (FTA-ABS)
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Microscopy of chancre fluid using Dark Ground Illumination
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Chemiluminescent microparticle immunoassays (CMIA)
Treatment
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Originally there were NO effective treatments available
for syphilis.
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The earliest treatments most commonly utilised
guaiacum wood and mercury. These were administered
many ways including by mouth, as an ointment or by
fumigation.
Fumigation
“for one pleasure a thousand pains”
Treatment
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1910 – drugs containing arsenic were
introduced. These included Salvarsan and
Neosalvarsan.
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Later the discovery that high fevers could help
cure syphilis saw the introduction of coinfection with malaria.
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Penicillin was introduced in 1943 and still
remains the treatment of choice today, usually
in the form Benzathine penicillin.
Prevention
No sexual
contact!
THE TUSKEGEE EXPERIMENT
1932 – 16th November 1972
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Conducted in Tuskegee, Alabama with the purpose of
“watching what would happen when syphilis was left
untreated”.
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Involved 600 poor African-American farmers and share
croppers, chosen by officials of the Public Health Service.
400 of the ‘subjects’ had syphilis.
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Incentives for participation included warm meals, free
burial, and free medical care.
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It was also arranged for none of these subjects to be
drafted into World War 2 as the syphilis would have been
picked up and treated.
The Tuskegee Experiment
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Each subject was given regular complete physical
exams, including x-rays and ECG’s. They also
submitted for spinal taps.
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None of the patients received ANY treatment for the
syphilis nor were they informed of their condition.
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Surveys were produced in 1932, 1938, 1948 and 1952.
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No concerns were ever raised about the welfare of
these men or their families.
The Tuskegee Experiment
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The study was finally exposed in 1972, ending on
November 16.
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28 of the men died of syphilis, 100 others died as a
result of syphilis-related complications.
At least 40 wives were affected and 19 children
contracted the disease congenitally.
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July 23 1973 – a $1.8 billion law suit was filed against
the institutions and individuals involved.
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December 1974 – a $10 million out-of-court settlement
was made, to be divided between ALL those affected.
The Tuskegee Experiment
Finally on May 11 1997, 65 years after
the study begin, President Clinton issued
a formal apology to the victims and their
families on behalf of the US government.
“What the United States did was shameful
and I am sorry”
The Tuskegee Experiment is one of the best documented
cases of unethical human medical experimentation of the
20th century.