From a purely brass-tacks scientific perspective, syphilis is just the name given to a three-stage disease caused by the bacteria Treponema pallidum. It is essentially transmitted through mucous membranes or broken skin, which is why the overwhelming method of transmission is unprotected sexual contact and the risk goes up rapidly in proportion to riskier sexual practices and increased number of sexual partners. It is also worth noting that the sexual partners of people with a high number of sexual partners are also more likely to have an increased number of sexual partners themselves, thus compounding the increased risk of exposure to syphilis.
Syphilis can also be transmitted directly from an infected mother to her unborn child. The untreated disease usually progresses through three distinct stages, punctuated by periods of spontaneous remission (often mistaken for an actual resolution of the disease) in between. The first stage is usually a single, painless, firm lesion on the skin called a chancre (most commonly on the genitals or anus, but it can occur elsewhere). The second stage is usually a more disseminated rash across the skin, notable for its presence on the palms and soles of the feet. The third and final stage is usually characterized by diffuse systemic involvement, but most notably including severe damage to the central nervous system and cardiovascular system. This third and final stage may occur decades after the initial infection, and often results in the death of the individual.
The exact geographic origin of syphilis is still a widely debated subject. Some theories posit that it originated in the Americas and was brought back to Europe by Christopher Columbus’ crew. Others posit that it originated in Africa or the Old World. And others suggest that it was endemic globally. There is good evidence of treponemal disease (syphilis) in Native Americans prior to 1492, thus making the American origin plausible. However, there is also some evidence of treponemal disease in Europe prior to 1493 (when Columbus’ crew returned), although this evidence is not as strong and is disputed by many. There is also evidence that syphilis originated in either cattle or sheep and made a zoonotic transmission to humans. This, of course, raises the possibility of --to put it delicately-- let’s just say a rather unorthodox approach to “animal husbandry”. Although it is also plausible that the jump to humans could have happened through less disturbing means, such as butchering the carcasses of infected animals with broken skin.
Over the centuries, what we now call “syphilis” has gone by many names and has often been conflated and confused with other sexually transmitted diseases -- and even diseases such as leprosy and leishmaniasis. Our current name “syphilis” actually originated from a set of fictional novels written in 1530 by the Italian poet Girolamo Fracastoro called, “Syphilis sive Morbus Gallicus”. In these books, Fracastoro ascribes the origin of the disease to a curse placed on the people of ancient Greece because a shepherd named Syphilis refused to worship the god Apollo. As one might expect, there is rampant speculation about many prominent historical figures who are believed to have had syphilis, ranging from Leo Tolstoy and Friedrich Nietzsche, to Al Capone and Adolf Hitler.
The actual bacterium responsible for syphilis (Treponema pallidum) was not identified until 1905 by Fritz Schaudinn and Erich Hoffmann in Germany, and the first (moderately) effective treatment for syphilis did not come until 1910. It was an arsenic-based drug called arsphenamine and, while it was effective in the treatment of syphilis, it carried considerable downsides and adverse side effects -- as one would expect from a drug derived from arsenic! The real game changer for the successful treatment of syphilis came with the discovery of penicillin. Even though penicillin was discovered by Alexander Fleming in 1928, it was not mass produced and introduced to the American market until 1943.
While syphilis is a potentially fatal disease, the good news is that it can now be easily tested for and successfully treated with a single injection of long-acting penicillin. Recognizing the disease early is important and we will cover that in the next blog post.
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