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I changed "antibiotic" (a substance made by one species that is poisonous to another) to "antimicrobial" (general term which also includes synthetic agents such as Salvarsan)
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|doi=10.1136/bmj.2.466.605}}</ref>{{Better source|date=May 2010}} One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box that caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body.{{Citation needed|date=May 2010}} The use of mercury was the earliest known suggested treatment for syphilis.{{Verify source|date=May 2010}} This has been suggested to date back to ''[[The Canon of Medicine]]'' (1025) by the [[Medicine in medieval Islam|Persian physician]], [[Avicenna|Ibn Sina]] (Avicenna).,<ref>{{Cite journal|first=Philip O.|last=Ozuah|title=Mercury poisoning|journal=Current Problems in Pediatrics|volume=30|issue=3|date=March 2000|pages=91–99 [91]|doi=10.1067/mps.2000.104054}}</ref> although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used it for this purpose in 1496.{{Citation needed|date=May 2010}}
|doi=10.1136/bmj.2.466.605}}</ref>{{Better source|date=May 2010}} One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box that caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body.{{Citation needed|date=May 2010}} The use of mercury was the earliest known suggested treatment for syphilis.{{Verify source|date=May 2010}} This has been suggested to date back to ''[[The Canon of Medicine]]'' (1025) by the [[Medicine in medieval Islam|Persian physician]], [[Avicenna|Ibn Sina]] (Avicenna).,<ref>{{Cite journal|first=Philip O.|last=Ozuah|title=Mercury poisoning|journal=Current Problems in Pediatrics|volume=30|issue=3|date=March 2000|pages=91–99 [91]|doi=10.1067/mps.2000.104054}}</ref> although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used it for this purpose in 1496.{{Citation needed|date=May 2010}}


As the disease became better understood, more effective treatments were found. The first antibiotic to be used for treating disease was the [[arsenic]]-containing drug [[Arsphenamine|Salvarsan]], developed in 1908 by [[Sahachiro Hata]] while working in the laboratory of [[Nobel prize]] winner [[Paul Ehrlich]]. This was later modified into [[Neosalvarsan]]. Unfortunately, these drugs were not 100% effective, especially in late disease.{{Citation needed|date=May 2010}} It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time [[malaria]] was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of [[pyrotherapy]]). This was considered an acceptable risk because the malaria could later be treated with [[quinine]], which was available at that time.{{Citation needed|date=May 2010}} Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of [[penicillin]], and its widespread [[manufacture]] after [[World War II]] allowed syphilis to be effectively and reliably cured.<ref name=Brown>{{cite book | author=Brown, Kevin| year=2006 | title=The Pox: The Life and Near Death of a Very Social Disease | location=Stroud | publisher=WSutton | pages=85–111, 185–91}}</ref> This discovery was championed by [[Julius Wagner-Jauregg]],<ref>{{cite journal | author = Raju T | title = Hot brains: manipulating body heat to save the brain | doi= 10.1542/peds.2005-1934 | journal = Pediatrics | volume = 117 | issue = 2 | pages = e320–1 | year = 2006 | pmid = 16452338 |url=http://pediatrics.aappublications.org/cgi/content/full/117/2/e320}}</ref> who won the 1927 [[Nobel Prize for Medicine]] for his work in this area.
As the disease became better understood, more effective treatments were found. The first antimicrobial to be used for treating disease was the [[arsenic]]-containing drug [[Arsphenamine|Salvarsan]], developed in 1908 by [[Sahachiro Hata]] while working in the laboratory of [[Nobel prize]] winner [[Paul Ehrlich]]. This was later modified into [[Neosalvarsan]]. Unfortunately, these drugs were not 100% effective, especially in late disease.{{Citation needed|date=May 2010}} It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time [[malaria]] was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of [[pyrotherapy]]). This was considered an acceptable risk because the malaria could later be treated with [[quinine]], which was available at that time.{{Citation needed|date=May 2010}} Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of [[penicillin]], and its widespread [[manufacture]] after [[World War II]] allowed syphilis to be effectively and reliably cured.<ref name=Brown>{{cite book | author=Brown, Kevin| year=2006 | title=The Pox: The Life and Near Death of a Very Social Disease | location=Stroud | publisher=WSutton | pages=85–111, 185–91}}</ref> This discovery was championed by [[Julius Wagner-Jauregg]],<ref>{{cite journal | author = Raju T | title = Hot brains: manipulating body heat to save the brain | doi= 10.1542/peds.2005-1934 | journal = Pediatrics | volume = 117 | issue = 2 | pages = e320–1 | year = 2006 | pmid = 16452338 |url=http://pediatrics.aappublications.org/cgi/content/full/117/2/e320}}</ref> who won the 1927 [[Nobel Prize for Medicine]] for his work in this area.


===History of diagnosis===
===History of diagnosis===

Revision as of 20:50, 31 March 2011

Syphilis
SpecialtyInfectious diseases, dermatology Edit this on Wikidata

Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum subspecies pallidum. The primary route of transmission of syphilis is through sexual contact however it may also be transmitted from mother to fetus during pregnancy or at birth resulting in congenital syphilis.

The signs and symptoms of syphilis vary depending on which of the four stages it presents in (primary, secondary, latent, and tertiary). The primary stage typically presents with a single chancre, secondary syphilis with a diffuse rash, latent with little to no symptoms, and tertiary with gummas, neurological, or cardiac symptoms. Diagnosis is usually via blood tests. It can be effectively treated with antibiotics, specifically intramuscular penicillin G.

Syphilis is believed to have infected 12 million people worldwide in 1999 with greater than 90% of cases in the developing world. Rates of infection have increased during the 2000s in many countries.

Signs and symptoms

Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary.[1] It may also occur congenitally.[2] It has been referred to as the “great imitator of skin diseases" due to its varied presentations.[1]

Primary

Primary chancre of syphilis on the hand.

Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of another person .[3] Approximately 3–90 days after the initial exposure (average 21 days) a skin lesion appears at the point of contact called a chancre.[1] This is classically (40% of the time) a single firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3 cm in size.[1] Occasionally multiple lesions may be present.[1] Lesions outside of the genitals may be painful.[1] Lymph node enlargement frequently (80%) occurs around the area of infection.[1] The lesion may persist for 3 to 6 weeks without treatment.[1]

Secondary

Secondary syphilis occurs approximately 4 to 10 weeks after the primary infection.[1] There are many different manifestations of secondary disease. There may be a symmetrical reddish-pink non-itchy rash on the trunk and extremities including the palms and soles.[1][4] The rash may become maculopapular or pustular.[1] On mucous membranes it may form flat, broad, whitish, wart-like lesions known as condyloma latum.[1] All of these lesions are infectious harboring bacteria.[1] Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache.[1] Rare manifestations include hepatitis, kidney disease, arthritis, periostitis, optic neuritis, uveitis, and interstitial keratitis.[1][5] The acute symptoms usually resolve after 3 to 6 weeks.[5]

  • Typical presentation of secondary syphilis with a rash on the palms of the hands.
    Typical presentation of secondary syphilis with a rash on the palms of the hands.
  • Reddish papules and nodules over much of the body due to secondary syphilis
    Reddish papules and nodules over much of the body due to secondary syphilis
  • Intensely itchy papulonodular rash of secondary syphilis
    Intensely itchy papulonodular rash of secondary syphilis

Latent

Latent syphilis is defined as having serologic proof of infection without signs or symptoms of disease.[3] It is further described as either early (less than 1 yr after secondary syphilis) or late (more than 1 year after secondary syphilis).[5] Early latent syphilis may have relapses of symptoms.[5] Late latent syphilis is asymptomatic and not as contagious as early latent syphilis.[5]

Tertiary

Model of the head of a patient with tertiary syphilis.

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection and may be divided into three different forms: late neurosyphilis (6.5%), cardiovascular syphilis (10%) and gummatous syphilis (15%).[1][5] Without treatment a third of people develop tertiary disease.[5] People with tertiary syphilis are not infectious.[1]

Gummatous

Gummatous syphilis or late benign syphilis usually occurs 1–46 years after the initial infection, with an average of 15 years.[1] This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size.[1] They typically affect the skin, bone, and liver, but can occur anywhere.[1]

Late neurosyphilis

Neurosyphilis refers to an infection involving the central nervous system. It may occur early being either asymptomatic or in the form of syphilitic meningitis or late as meningovascular syphilis, general paresis or tabes dorsalis.[1] Late neurosyphilis typically occurs 4 to 25 years after the initial infection.[1] Meningovascular syphilis typically presents with apathy and seizure, general paresis with dementia and tabes dorsalis is associated with poor balance and lightening pains in the lower extremities.[1]

Cardiovascular

Cardiovascular syphilis usually occurs 10–30 years after the initial infection.[1] The most common complications is syphilitic aortitis which may result in aneurysm formation.[1]

Congenital

Congenital syphilis may occur during pregnancy or during the birth process.[6] Most infants (2/3) are born without symptoms.[6] Common symptoms that then develop over the first couple years of life include: hepatosplenomegaly (70%), rash (70%), fever (40%), neurosyphylis (20%), pneumonitis (20%).[6] If untreated late congenital syphilis may occur in 40% including: saddle nose deformation, Higoumenakis sign, saber shin, or Clutton's joints among others.[6]

Cause

Syphilis is caused by the bacteria Treponema pallidum subspecies pallidum, for which humans are the only known natural reservoir.[2] It is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus being able to pass through intact mucus membranes or compromised skin.[1][2] It is thus transmissible by kissing, oral, vaginal, and anal sex.[1] Approximately 30 to 60% of those exposed to primary or secondary syphilis will get the disease.[5] Most (60%) of new cases in the United States occur in men who have sex with men.[1] It can be transmitted via blood products. However, it is tested for in many countries and thus the risk is low.[1] The risk of transmission from sharing needles appears limited.[1] Three other human diseases are caused by related Treponema pallidum including: yaws (subspecies pertenue), pinta (subspecies carateum) and bejel (subspecies endemicum).[1] Unlike subtype pallidum they do not cause neurological disease.[6]

Diagnosis

Poster for testing of syphilis, showing a man and a woman bowing their heads in shame (ca. 1936).

Syphilis may be confirmed either via blood tests or direct visualization using microscopy.[1] Typical diagnosis is with blood tests using nontreponemal and/or treponemal tests.[1] Nontreponemal test are used initially and include venereal disease research laboratory (VDRL) and rapid plasma reagin however as these test occasionally are falsely positive confirmation is required with a treponemal test such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs).[1] False positives on the nontreponemal tests can occur with some viral infections such as (varicella and measles), as well as with lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy.[3] Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominate lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection.[1][3]

Prevention

As of 2010 there is no vaccine effective for prevention.[2] Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis, as is the proper use of a latex condom. Condom use, however, does not completely eliminate the risk.[7][8] Syphilis cannot be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.[9]

Treatment

Depression-era U.S. poster advocating early syphilis treatment

Early infections

The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular penicillin G.[2] Doxycycline and tetracycline are alternative choice; however, it cannot be used in pregnant women.[2] Antibiotic resistance has developed to a number of agents including macrolides, clindamycin, and rifampin.[2] Ceftriaxone may be as effective as penicillin based treatment.[1]

Late infections

For neurosyphilis due to the poor penetration of penicillin G into the central nervous system it is recommended that those affected be given large doses of intravenous penicillin for a minimum of 10 days.[1][2] If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted.[1] Other late presentations may be treated with once weekly intramuscular penicillin G for three weeks.[1] If allergic as in the case of early disease doxycycline or tetracycline may be used but for a longer duration.[1] Treatment at this point will limit further progression but has only slight effect on damage which has already occurred.[1]

Jarisch-Herxheimer reaction

One of the potential side effects of treatment is the Jarisch-Herxheimer reaction.[1] It frequently starts within one hour and lasts for 24 hours with symptoms of fever, muscles pains, headache, and tachycardia.[1] It is caused by cytokines released by the immmune system in response to endotoxins released from rupturing syphilis bacteria.[1]

Prognosis

Syphilis increase the risk of HIV transmission by 2 to 5 times and co infection is common (30-60% in a number of urban centers).[1][2] Untreated it has a mortality of 8% to 58% with a greater death rate in males.[1]

Epidemiology

Age-standardized death from syphilis per 100,000 inhabitants in 2004.[10]
  no data
  <35
  35-70
  70-105
  105-140
  140-175
  175-210
  210-245
  245-280
  280-315
  315-350
  350-500
  >500
Syphilis—Reported Cases by Stage of Infection, United States, 1941–2009

Syphilis is believed to have infected 12 million people in 1999 with greater than 90% of cases in the developing world.[2] It affects between 700,000 and 1.6 million pregnacies a year resulting in spontaneous abortions, stillbirths, and congenital syphilis.[6] In Sub Saharan Africa syphilis contributes to approximately 20% of perinatal deaths.[6]

In the developed world, syphilis infections were in decline until the 1980s and 1990s due to widespread use of antibiotics. Since the year 2000, rates of syphilis have been increasing in the USA, UK, Australia and Europe primarily among men who have sex with men.[2] This is attributed to unsafe sexual practices.[2] Increased rates among heterosexually have occurred in China and Russia since the 1990s.[2]

History

Alternative names

The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his epic noted poem, written in Latin, titled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him.[failed verification] From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").[11]

Until that time, as Fracastoro notes,[failed verification] syphilis had been called the "French disease" in Italy, Poland and Germany, and the "Italian disease" in France. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", the Turks called it the "Christian disease" or "Frank disease" (frengi) and the Tahitians called it the "British disease". These "national" names are due to the disease often being spread by foreign sailors and soldiers during their frequent sexual contact with local prostitutes.[citation needed]

During the 16th century, it was called "great pox" in order to distinguish it from smallpox. In its early stages, the great pox produced a rash similar to smallpox (also known as variola).[citation needed] However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues"[12] (or Lues venerea, Latin for "venereal plague") and "Cupid's disease"[citation needed] have also been used to refer to syphilis. In Scotland, syphilis was referred to as the Grandgore. The ulcers suffered by British soldiers in Portugal were termed "The Black Lion".[13]

Origins

The exact origin of syphilis is unknown.[1] Three theories have been proposed. It is generally agreed upon by historians and anthropologists that syphilis was present among the indigenous peoples of the Americas before Europeans traveled to and from the New World. However, whether strains of syphilis were present in the entire world for millennia, or if the disease was confined to the Americas in the pre-Columbian era, is debated.[citation needed]

  • In 79 CE the Roman town of Pompeii was destroyed by a volcanic eruption. The entombed remains of the population provide insights into their health as many infectious diseases leave marks in tooth enamel. The remains of one pair of twins show what are almost certainly the signs of congenital syphilis.[14]
  • The "pre-Columbian theory" holds that syphilis was present in Europe before the discovery of the Americas by Europeans. Some scholars during the 18th and 19th centuries believed its symptoms were described by Hippocrates in Classical Greece in its venereal/tertiary form.[15] There are other suspected syphilis findings for pre-contact Europe, including at a 13–14th century Augustinian friary in the northeastern English port of Kingston upon Hull. This city's maritime history, with its continual arrival of sailors from distant places, is thought to have been a key factor in the transmission of syphilis.[16] Carbon-dated skeletons of monks who lived in the friary showed bone lesions that supporters say are typical of venereal syphilis, although this is disputed by critics of this theory. Skeletons in pre-Columbus Pompeii and Metaponto in Italy with damage similar to that caused by congenital syphilis have also been found,[17][18] although the interpretation of this evidence has been disputed.[19] Douglas Owsley, a physical anthropologist at the Smithsonian Institution, and other supporters of this idea say that many medieval European cases of leprosy, colloquially called lepra, were actually cases of syphilis. Although folklore claimed that syphilis was unknown in Europe until the return of the diseased sailors of the Columbian voyages,

    ... syphilis probably cannot be "blamed"—as it often is—on any geographical area or specific race. The evidence suggests that the disease existed in both hemispheres from prehistoric times. It is only coincidental with the Columbus expeditions that the syphilis previously thought of as "lepra" flared into virulence at the end of the fifteenth century.[20]

    Lobdell and Owsley wrote that a European writer who recorded an outbreak of "lepra" in 1303 was "clearly describing syphilis."[20]
  • The "Columbian Exchange theory" holds that syphilis was a New World disease brought back by Columbus and Martin Alonso Pinzon. They cite documentary evidence linking crewmen of Columbus's voyages to the Naples syphilis outbreak of 1494.[21][failed verification] This theory is supported by genetic studies of venereal syphilis and related bacteria, which found a disease intermediate between yaws and syphilis in Guyana, South America.[22][23]
  • Finally, historian Alfred Crosby suggests both theories are partly correct in a "combination theory". Crosby says that the bacterium that causes syphilis belongs to the same phylogenetic family as the bacteria that cause yaws and several other diseases. Despite the tradition of assigning the homeland of yaws to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease having been present in pre-Columbian Europe, Africa, or Asia.

Crosby writes, "It is not impossible that the organisms causing treponematosis arrived from America in the 1490s...and evolved into both venereal and non-venereal syphilis and yaws."[24] However, Crosby considers it more likely that a highly contagious ancestral species of the bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. He hypothesizes that "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases."[24]

European outbreak

A medical illustration attributed to Albrecht Dürer (1496) depicting a person with syphilis. Here, the disease is believed to have astrological causes.

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples.[25] The French may have caught it via Spanish mercenaries serving King Charles of France in that siege.[20] From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today."[26] The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.

Researchers concluded that syphilis was carried from the New World to Europe after Columbus' voyages. Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495 resulting in the spreading of the disease across Europe and as many as 5 million deaths.[27][28] The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions and low immunity of the population of Europe.[29] Syphilis was a major killer in Europe during the Renaissance.[30] In his Serpentine Malady (Seville, 1539) Ruy Diaz de Isla estimated that over a million people were infected in Europe.[31]

Historical treatments

There were originally no effective treatments for syphilis. The Spanish priest Francisco Delicado wrote El modo de adoperare el legno de India (Rome, 1525) about the use of Guaiacum in the treatment of syphilis. He himself suffered from syphilis.[citation needed] Nicholas Culpeper recommended the use of heartsease (wild pansy), an herb with antimicrobial activities.[32][failed verification] Another common remedy was mercury: the use of which gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury".[33] It was administered multiple ways including by mouth,[citation needed] by rubbing it on the skin[citation needed] and by injection.[34][better source needed] One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box that caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body.[citation needed] The use of mercury was the earliest known suggested treatment for syphilis.[verification needed] This has been suggested to date back to The Canon of Medicine (1025) by the Persian physician, Ibn Sina (Avicenna).,[35] although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used it for this purpose in 1496.[citation needed]

As the disease became better understood, more effective treatments were found. The first antimicrobial to be used for treating disease was the arsenic-containing drug Salvarsan, developed in 1908 by Sahachiro Hata while working in the laboratory of Nobel prize winner Paul Ehrlich. This was later modified into Neosalvarsan. Unfortunately, these drugs were not 100% effective, especially in late disease.[citation needed] It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of pyrotherapy). This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time.[citation needed] Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured.[36] This discovery was championed by Julius Wagner-Jauregg,[37] who won the 1927 Nobel Prize for Medicine for his work in this area.

History of diagnosis

Portrait of Gerard de Lairesse by Rembrandt van Rijn, ca. 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, suffered from congenital syphilis that severely deformed his face and eventually blinded him.[38]

In 1905, Schaudinn and Hoffmann discovered Treponema pallidum in tissue of patients with syphilis.[39] One year later, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the detection and prevention of syphilis.[citation needed] By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wassermann test.[citation needed] Both of these early tests have been superseded by newer analytical methods.

While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, proving conclusively that Treponema pallidum was the cause of syphilis.[40][dead link] Prior to Noguchi's discovery, syphilis had been a burden to humanity in many lands. Without its cause being understood, it was sometimes misdiagnosed and often misattributed to damage by political enemies.

Notable cases

The Russian author Leo Tolstoy suffered from syphilis during his youth, which was treated using contemporary arsenic treatment.[41] A recent article in the European Journal of Neurology (June 2004) hypothesized that the founder of communism in Russia, Vladimir Ilyich Lenin, died of neurosyphilis.[42]

Society and culture

Art

The artist Jan van der Straet painted a scene of a wealthy man receiving treatment of syphilis with the tropical wood guaiacum sometime around 1580.[45] The title of the work is "Preparation and Use of Guayaco for Treating Syphilis." That the artist chose to include this image in a series of works celebrating the New World indicates how important a "cure" (however ineffective) for syphilis was to the European elite at that time. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks.[46]

Literature

Moll dies of syphillis, Hogarth's A Harlot's Progress.

It has been suggested that the main character in Edgar Allan Poe's "The Tell-Tale Heart" may have been infected with neurosyphilis, due to his strange obsessions and apparent insanity.[citation needed] Francisco de Quevedo puns in his Buscón[47] about a nose entre Roma y Francia meaning both "between Rome and France" and "between snub and eaten by the French illness".[clarification needed]

William Hogarth's works frequently show his subject's infection with syphilis. Two examples are A Harlot's Progress and Marriage à-la-mode. In both instances it is used to indicate the moral profligacy of the infected. Some critics have argued that the character of Edward Rochester's first wife, Bertha, in Charlotte Brontë's novel Jane Eyre, suffers from the advanced stages of syphilitic infection, general paralysis of the insane, and point to corroborative evidence within the text to substantiate this view.[48]

In Eça de Queiroz's novel written in 1870, 'The Mystery of the Sintra Road', some of the characters have syphilis, and it plays an important role in the plot of a recent movie adaptation.[49][failed verification]

Tuskegee study

Main article: Tuskegee syphilis experiment

One of the best-documented US cases of unethical human medical experimentation in the twentieth century was the Tuskegee syphilis study. The study took place in Tuskegee, Alabama, and was supported by the U.S. Public Health Service (PHS) in partnership with the Tuskegee Institute.[50] The study began in 1932, when syphilis was a widespread problem and there was no effective treatment or cure. The study was designed to measure the progression of untreated syphilis.

By 1947 penicillin had been validated as an effective cure for syphilis and was becoming widely used by doctors and public health centers to treat the disease. PHS study directors continued the study, denying patients treatment by penicillin, and actively discouraging them from having penicillin administered by other sources. The men were never advised that they had syphilis, nor were they offered a treatment.[citation needed] The study did not end until 1972.

Gallery

  • Electron micrograph of Treponema pallidum
    Electron micrograph of Treponema pallidum
  • Syphilis lesions on a patient's back
    Syphilis lesions on a patient's back
  • Syphilis lesions on a patient's chest
    Syphilis lesions on a patient's chest
  • Chancres on the penile shaft due to a primary syphilitic infection
    Chancres on the penile shaft due to a primary syphilitic infection
  • Secondary syphilis manifested perineal condyloma lata lesions.
    Secondary syphilis manifested perineal condyloma lata lesions.
  • Gumma of the nose due to long standing tertiary syphilis
    Gumma of the nose due to long standing tertiary syphilis
  • Effect of syphilis on the skull.
    Effect of syphilis on the skull.
  • Star Wars themed parade float promoting syphilis testing at a 2005 parade in Seattle, Washington, United States.
    Star Wars themed parade float promoting syphilis testing at a 2005 parade in Seattle, Washington, United States.

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au Kent ME, Romanelli F (2008). "Reexamining syphilis: an update on epidemiology, clinical manifestations, and management". Ann Pharmacother. 42 (2): 226–36. doi:10.1345/aph.1K086. PMID 18212261. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ a b c d e f g h i j k l m Stamm LV (2010). "Global challenge of antibiotic-resistant Treponema pallidum". Antimicrob. Agents Chemother. 54 (2): 583–9. doi:10.1128/AAC.01095-09. PMC 2812177. PMID 19805553. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. ^ a b c d Pickering LK, ed. (2006). "Syphilis". Red Book. Elk Grove Village, IL: American Academy of Pediatrics. pp. 631–644.
  4. ^ Dylewski J, Duong M (2 January 2007). "The rash of secondary syphilis". CMAJ. 176 (1): 33–5. doi:10.1503/cmaj.060665. PMC 1764588. PMID 17200385.
  5. ^ a b c d e f g h Bhatti MT (2007). "Optic neuropathy from viruses and spirochetes". Int Ophthalmol Clin. 47 (4): 37–66, ix. doi:10.1097/IIO.0b013e318157202d. PMID 18049280.
  6. ^ a b c d e f g Woods CR (2009). "Congenital syphilis-persisting pestilence". Pediatr. Infect. Dis. J. 28 (6): 536–7. doi:10.1097/INF.0b013e3181ac8a69. PMID 19483520. {{cite journal}}: Unknown parameter |month= ignored (help)
  7. ^ Koss CA, Dunne EF, Warner L (2009). "A systematic review of epidemiologic studies assessing condom use and risk of syphilis". Sex Transm Dis. 36 (7): 401–5. doi:10.1097/OLQ.0b013e3181a396eb. PMID 19455075. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ How can Syphilis be Prevented?, Centers for Disease Control and Prevention
  9. ^ Centers for Disease Control (CDC) (05-2004). "STD Facts - Syphilis". Centers for Disease Control. Retrieved 2007-05-30. {{cite web}}: Check date values in: |date= (help)
  10. ^ "WHO Disease and injury country estimates". World Health Organization. 2004. Retrieved Nov. 11, 2009. {{cite web}}: Check date values in: |accessdate= (help)
  11. ^ "Syphilis". Online Etymology Dictionary. 2001.
  12. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
  13. ^ Rudy's List of Archaic Medical Terms (2007-04-27). "B". Antiquus Morbus. Retrieved 2008-04-28.
    Referencing:
    Robley Dunglison (1874). Dunglison's Medical Dictionary – A Dictionary of Medical Science. Philadelphia, USA: Collins.
  14. ^ Beard, Mary (First published 2010- Dec 14). "Pompeii skeletons reveal secrets of Roman family life". BBC Pompeii: Life and Death in a Roman Town will be broadcast on BBC Two at 2100 GMT on Tuesday 14 December. Retrieved 2010-12-14. {{cite web}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
  15. ^ Bollaert, WM (1864), Introduction of Syphilis from the New World, I will now briefly allude to some historical accounts on this subject, particularly as regards the Old World. In the Aphorisms of Hippo crates, 400 b.c., and in the Sentences of Celsus, 400 years after Hippocrates, as found in Sprengell's translations, in 1708. When Sprengell alludes to his own added Aphorisms " On the French dis-ease," he says, it was just known to former more temperate ages, and, in a note, how far it was known in former ages, he refers to Ecclesiasticus, c. 19, v. 2, 3. Hippocrates, in. ; Epidemics, ill., 41, 74, 59, and i. Be Morbus Mulierum, 127. Galen, lib. iv. ; Meth. c. 5, and lib. i. De Genet:, c. 23 ; lib. iii. Epidemics, sec. 3, com. 25. Pliny His. Nat., lib. 26, c. i. Avicen, lib. 2. Valesius; Rhodius ; Vigo-nius, Lib. de Morb. Gall., c. &c. And that it does not, according to the vulgar opinion, derive its origin from Naples, France, East or West Indies. Josephus, c. xi., p. 108, says, when on the subject of purification, that Moses ordered those who had gonorrhoea should not come into the city.
  16. ^ Keys D (2000-07-24). "English syphilis epidemic pre-dated European outbreaks by 150 years". London: Independent News and Media Limited. Retrieved 2007-09-22.{{cite news}}: CS1 maint: date and year (link)
  17. ^ Henneberg M, Henneberg RJ (1994). "Treponematosis in an Ancient Greek colony of Metaponto, Southern Italy 580-250 BCE". In O Dutour, G Palfi, J Berato, J-P Brun (eds) (ed.). The Origin of Syphilis in Europe, Before or After 1493?. Toulon-Paris: Centre Archeologique du Var, Editions Errance. pp. 92–98. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  18. ^ Henneberg M, Henneberg RJ (2002). "Reconstructing Medical Knowledge in Ancient Pompeii from the Hard Evidence of Bones and Teeth". In J Renn, G Castagnetti (eds) (ed.). Homo Faber: Studies on Nature. Technology and Science at the Time of Pompeii,. Rome: "L’ERMA" di Bretschneider. pp. 169–187. {{cite book}}: |editor= has generic name (help)
  19. ^ Rose M (1997). "Origins of Syphilis". Archaeology. 50 (1). {{cite journal}}: Unknown parameter |month= ignored (help)
  20. ^ a b c Lobdell J, Owsley D (1974). "The origin of syphilis". Journal of Sex Research. 10 (1): 76–79. doi:10.1080/00224497409550828. {{cite journal}}: Unknown parameter |month= ignored (help) (via JSTOR)
  21. ^ Baker, et al.
  22. ^ Debora MacKenzie (15 January 2008). "Columbus blamed for spread of syphilis". NewScientist.
  23. ^ Harper KN, Ocampo PS, Steiner BM; et al. (2008). "On the origin of the treponematoses: a phylogenetic approach". PLoS Negl Trop Dis. 2 (1): e148. doi:10.1371/journal.pntd.0000148. PMC 2217670. PMID 18235852. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  24. ^ a b Crosby, Alfred. The Columbian Exchange: Biological and Cultural Consequences of 1492, 225.
  25. ^ Oriel, J.D. (1994). The Scars of Venus: A History of Venereology. London: Springer-Verlag. ISBN 354019844X.
  26. ^ Diamond, Jared (1997). Guns, Germs and Steel. New York: W.W. Norton. p. 210. ISBN 848306667X.
  27. ^ CBC News Staff (2008). "Study traces origins of syphilis in Europe to New World". Retrieved 2008-01-15. {{cite news}}: Unknown parameter |month= ignored (help)
  28. ^ Harper, Kristin; et al. (2008). "On the Origin of the Treponematoses: A Phylogenetic Approach". Retrieved 2008-01-21. {{cite web}}: Explicit use of et al. in: |last= (help); Unknown parameter |month= ignored (help)
  29. ^ "Genetic Study Bolsters Columbus Link to Syphilis", New York Times, January 15, 2008
  30. ^ "Columbus May Have Brought Syphilis to Europe", LiveScience
  31. ^ "Pox and Paranoia in Renaissance Europe". History Today.
  32. ^ Nicholas Culpeper. "A complete herbal".
  33. ^ Hanlon M (7 June 2007). "The magical properties of Mercury, the metal the EU wants to ban". The Daily Mail. Retrieved 2007-08-07.
  34. ^ Thomas James Walker (1869). "The Treatment of Syphilis by the Hypodermic Injection of the Salts of Mercury". Br Med J. 2 (466): 605–608. doi:10.1136/bmj.2.466.605. PMC 2261112. PMID 20745696. {{cite journal}}: Unknown parameter |month= ignored (help)
  35. ^ Ozuah, Philip O. (March 2000). "Mercury poisoning". Current Problems in Pediatrics. 30 (3): 91–99 [91]. doi:10.1067/mps.2000.104054.
  36. ^ Brown, Kevin (2006). The Pox: The Life and Near Death of a Very Social Disease. Stroud: WSutton. pp. 85–111, 185–91.
  37. ^ Raju T (2006). "Hot brains: manipulating body heat to save the brain". Pediatrics. 117 (2): e320–1. doi:10.1542/peds.2005-1934. PMID 16452338.
  38. ^ The Metropolitan Museum of Art Bulletin, Summer 2007, pp. 55–56.
  39. ^ Fritz Richard Schaudinn, Erich Hoffmann: Vorläufiger Bericht über das Vorkommen von Spirochaeten in syphilitischen Krankheitsprodukten und bei Papillomen. Arbeiten aus dem kaiserlichen Gesundheitsamtes (Berlin), vol. 22, pp. 527–534, 1905.
  40. ^ "Noguchi, Hideyo". The Columbia Encyclopedia (Sixth ed.).
  41. ^ Wilson, A. G. (2001). Tolstoy: A Biography. New York: Norton. ISBN 0-393-32122-3.
  42. ^ Lerner V, Finkelstein Y, Witztum E (2004). "The enigma of Lenin's (1870–1924) malady". Eur. J. Neurol. 11 (6): 371–6. doi:10.1111/j.1468-1331.2004.00839.x. PMID 15171732. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  43. ^ Tithonus, Pednuad, J. "Eugen Sandow - Father of Bodybuilding". The Human Marvels. Retrieved 2008-09-17. At the time of his death in 1925, a cover story was released stating Sandow died prematurely at age 58 of a stroke shortly after pushing his car out of the mud. The actual cause of death was more likely due to complications from syphilis.{{cite news}}: CS1 maint: multiple names: authors list (link)
  44. ^ Tom Pendergast and Sara Pendergast (2000). St. James encyclopedia of popular culture. St. James Press. ISBN 9781558624047. ... speculates that the strongman's death may have been the result of an aortic aneurysm brought about by syphilis. ... {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
  45. ^ Johannes Stradanus undated brief review of works hosted at the University of York in the United Kingdom. Accessed August 6, 2007.
  46. ^ Jan van der Straet's "Preparation..." at commercial art site. Accessed August 6, 2007.
  47. ^ wikisource:es:Historia de la vida del Buscón: Libro Primero: Capítulo III: continues with [...] porque se le había comido de unas búas de resfriado, que aun no fueron de vicio porque cuestan dinero;: "[...] because it had been eaten by the bubons of a cold, which were not of vice because they cost money;".
  48. ^ See for example: Imlay, Elizabeth. Charlotte Bronte and the Mysteries of Love. p. 47-50.
  49. ^ [http://www.filmesfundo.com/omisteriodaestradadesintra "O Mist�rio da Estrada de Sintra"]. Retrieved 2007-08-07. {{cite web}}: replacement character in |title= at position 7 (help)
  50. ^ "U.S. Public Health Service Syphilis Study at Tuskegee". CDC. Retrieved 2010-07-07.

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