Written by Noah Surti, Peer Reviewed by Olivia N. McCollum, Edited by Courtney Coleman
Syphilis is a common sexually transmitted disease both in the present and throughout history, but it is relatively complex in its cultural and biological history. Syphilis is thought to have originated in Southwest Asia as the glaciers melted around 3000 BC as a non-sexually transmitted disease (1). It then spread to the Americas where it developed into a sexually transmitted disease. Syphilis was reintroduced to Europe by returning members of colonial expeditions to the Americas (2). The disease is especially known to have spread during times of war and was called the “French disease” after French soldiers who were known to contract it during the Franco-Italian wars (3).
Unfortunately, syphilis has been used throughout history to scapegoat minorities and people of color (2). Many other examples of syphilis being used as an insult for those groups of people who were seen as dirty or beneath society were quite common, especially towards women of the lower classes. Syphilis had a major impact on the United State when, in 1932, the completely unethical and tragic Tuskegee Syphilis study began. The study surveyed 399 Black, rural, and poor men with syphilis to evaluate their life outcomes and the experiment was done without informed consent (2). The participants were not told they had syphilis, and the researchers instead said they had cases of “bad blood,” a catch-all term used generally for different ailments. Even as syphilis treatments were released in the coming years, the research on these men continued for 40 years with the researchers going to extreme lengths to ensure the subjects of the study did not find out their true diagnosis. Eventually, the testing methods were leaked, and there was justifiable outrage over the racist nature of the study. The aftermath of the Tuskegee Syphilis Study still causes immense fear and distrust of the medical system for Black Americans today.
On the microbiological side, Syphilis is caused by the bacteria Treponema pallidum and is transmitted when mucosal surfaces (mouth or genitals), or open wounds, come into contact with infected syphilis lesions or bodily fluids (semen or vaginal discharge) which contain the bacteria (2). It can also be passed from mother to child through vertical transmission. The general symptoms of the disease are hard to pinpoint because syphilis develops in stages, each with a unique set of markers.
In primary syphilis, a small bump inside the vagina or reaction called a chancre appears, and it is often painless and unnoticeable (3,4). As the disease progresses to the secondary stage, people may develop pustules (historically given the euphemism, “purple flowers”) all over their bodies (2). Hair loss is also common and spurred the trend of men and women wearing large ostentatious wigs in the 17th and 18th centuries (2). More symptoms include swollen lymph nodes, muscle aches, fever, or sore throat. In tertiary syphilis, there may be damage to the brain, nerves, heart, lungs, blood vessels, liver, bones, and joints, which may result in death; however, tertiary symptoms may not appear for a long period of time due to most people who are infected experiencing the latent disease. Essentially, when latent syphilis occurs, patients show no symptoms. If left untreated, it can suddenly progress into one of the higher stages of syphilis, such as secondary or tertiary.
Neurosyphilis is one of the most advanced stages of the disease and occurs in tertiary syphilis patients (3,4). Neurosyphilis occurs when syphilis enters and attacks the brain. It is estimated that one-third of asylum patients in the 19th century suffered from neurosyphilis because it often presents itself as psychosis causing severe symptoms (3,4).
Congenital syphilis is also a major issue today (3,4,5). Similar to other STDs, when a mother is infected, the unborn child can contract syphilis and may die in the womb, be stillborn, or die soon after birth. Many babies are born with latent syphilis, which can manifest in deafness and deformities, or a rash immediately after birth. New Mexico recently mandated pregnant mothers to get screened for syphilis, as well as other STDs, and if they have syphilis, it must be treated (5).
Syphilis has no vaccine and can only be prevented through safe sex practices (3,4). Syphilis can only be treated via antibacterial penicillin since it is a bacterial illness. Pregnant women can receive antibiotics to prevent passing the disease to their child.
Syphilis infection rates have been growing in the US by 6.8% from 2019-2020, and the rate of congenital syphilis has only increased since 2013 (6). All in all, the disease is under a lot more control than in history, but its history teaches us that, as a disease, it is extremely dangerous when left untreated, which means that regular STD checks need to be instated for sexually active people so that it and many other STDs do not have the chance to harm people.
References
1. Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR. Brief history of syphilis. Journal of medicine and life. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/#:~:text=Around%203000%20BC%20the%20sexually,the%20rest%20of%20the%20world. Published March 15, 2014. Accessed October 28, 2022.
2. Hemarajata P. Revisiting the great imitator: The origin and history of syphilis. ASM.org.
https://asm.org/Articles/2019/June/Revisiting-the-Great-Imitator,-Part-I-The-Origin-a. Published June 17, 2019. Accessed October 28, 2022.
3. STD facts - syphilis. Centers for Disease Control and Prevention. https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm. Published February 10, 2022. Accessed October 28, 2022.
4. Mayo Clinic Staff. Syphilis. Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/syphilis/symptoms-causes/syc-20351756#:~:text=Syphilis%20is%20a%20bacterial%20infection,membrane%20contact%20with%20these%20sores. Published September 25, 2021. Accessed October 28, 2022.
5. New Mexico urges syphilis testing for all pregnant mothers. AP NEWS. https://apnews.com/article/health-new-mexico-syphilis-5ac277b827d59c5d8eca26e0410c1352. Published October 5, 2022. Accessed October
28, 2022.
6. National overview. Centers for Disease Control and Prevention.
https://www.cdc.gov/std/statistics/2020/overview.htm#Syphilis. Published April 12, 2022. Accessed October 29, 2022.
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on November 26, 2022.
Noah Surti is currently an intended public health major undergraduate at UC Berkeley.
Olivia N. McCollum is a first-year epidemiology MPH at the University of Washington.
Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs. Pandemics.