Syphilis is a disease that dates back to early times. The actual location that it originated is still debated. The main hypothesis about the origin of syphilis are recorded around the time that Christopher Columbus made his voyage to the New World and is referred to as the “Colombian theory. ” This theory describes the disease as being brought back to Europe when his crews were returning back from America in 1492. It was shortly after this time that the first epidemic of syphilis was recorded in Naples.
In 1495 an epidemic of a new and terrible disease broke out among the soldiers of Charles VIII of France when he invaded Naples in the first of the Italian Wars, and its subsequent impact on the peoples of Europe was devastating – this was syphilis, or grande verole, the “great pox”. Although it didn’t have the horrendous mortality of the bubonic plague, its symptoms were painful and repulsive – the appearance of genital sores, followed by foul abscesses and ulcers over the rest of the body and severe pains.
The remedies were few and hardly effective, the mercury inunctions and suffumigations that people endured were painful and many patients died of mercury poisoning” (1). Currently, a person diagnosed with syphilis is easily treated with a prescription of antibiotics after a visit to a healthcare professional. Due to widespread availability of an effective treatment and decreasing virulence of the bacteria, the severity of syphilis symptoms have drastically decreased. Thanks to these vast improvements with medicine, a person diagnosed with syphilis is now no longer left ridden with sores, painful treatments, or even the possibility of death.
Around the turn of the century, syphilis was almost completely eliminated in the United States according to Center for Disease Control documents. Within the past few years, new cases of syphilis have been on the rise, especially among gay males. “During 2014, there were 63,450 reported new cases of syphilis, compared to 47,352 estimated new diagnoses of HIV infection in 2013 and 350,062 cases of gonorrhea in 2014. 1, 2 Of syphilis cases, 19. 999 were of primary and secondary (P&S) syphilis, the earliest and most transmissible stages of syphilis.
During the 1990s, syphilis primarily occurred among heterosexual men and women of racial and ethnic minority groups; during the 2000s, however, cases increased among men who have sex with men (MSM). 3 In 2014, MSM accounted for 83% of all P&S syphilis cases among males in which sex of sex partner was known. ” (2). Currently, an untreated case of syphilis has a mortality rate between 8-58%, with males having a higher rate of death then that of woman. Syphilis is contracted from direct contact with a syphilitic sore, called a chancre, which are found on the external genitals or in the rectum.
The lesions can also be found in the mouth or on the lips. A person becomes infected after direct contact with the chancre during vaginal, anal, or oral sex. An infected mother can also pass syphilis through the bloodstream across the placenta to her unborn baby. A baby can also contract syphilis via direct contact with a syphilis lesion during vaginal delivery. “Syphilis has been called The Great Pretender, as its symptoms can look like many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months, or even years” (2).
Once direct contact occurs and a person is then infected, syphilis progresses through four distinct stages. Each stage can last for several years, and have a wide variety of symptoms throughout each stage. The first stage is known as the primary stage. In the primary stage, the only symptom noted is a single small, painless sore or chancre that appears between 10 days and 3 weeks after initial infection. The chancre usually heals within a month, regardless of whether the infected person receives treatment or not. If the bacteria is left untreated, it enters the bloodstream, progressing to the secondary stage.
Secondary syphilis presents as a nonitchy rash that is either localized (affecting one area) or systemic (affecting multiple areas), approximately two to eight weeks after the primary stage. Another common symptom during the secondary stage are rough reddish brown spots on the palms of the hands, and the soles of the feet. Mucous membrane lesions located in the mouth, vagina, and anus are also sypmtoms that mark the secondary stage. These mucous membrane lesions are known as condyloma lata. Condyloma lata, are large, raised, gray or white lesions, that may develop in warm moist areas of the groin, underarms, or mouth.
In addition to the rashes and lesions, an infected person may experience fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Like the primary stage, the secondary stage’s symptoms also will go away regardless of whether treatment is sought. If left untreated, the bacteria will progress to the latent stage, approximately 12 months after initial infection. The latent stage is defined as having serologic proof of infection without any sypmptoms of disease. It is subdivided into 2 stages: early latent and late latent, with treatment for both being different. The early latent period is the first year after the resolution of primary or secondary syphilis.
Asymptomatic patients who have a newly active serologic test after having a serologically negative test result within 1 year are also considered to be in the early latent period” (10). The third stage is also known as the hidden stage due to the infected person being essentially symptom free, yet serologically positive. During this time, the secondary symptoms may reappear, or the person may remain symptom free for years while progressing into the tertiary stage.
The last stage of syphilis is known as the tertiary stage. It causes systemic problems that affect the heart, brain, and nervous system also known as neurosyphilis. Neurosyphilis occurs 10 to 20 years after initial infection. It is further divided into 4 forms: asymptomatic, general paresis, meningovascular, and tabes dorsalis. During the stages of neurosyphilis, a person’s symptoms may include abnormal or inability to walk, lower limb paralysis, difficulty with concentration, mental illness, incontinence, tremors, and even death.