Syphilis Also Known as "The

Syphilis Also known as "the pox," "Lues," "Cupid's Disease," the "Great Imitator" of other diseases, or "Syph," syphilis is a potentially-devastating sexually-transmitted bacterial infection infamous for its famous victims (NIH, 2009). These unfortunate souls include Adolf Hitler, Al Capone, Vincent Van Gogh, Abraham Lincoln, Friedrich Nietzsche, and the composer Franz Schubert (Hayden, 2003). Although symptoms attributed to syphilis have been recorded since the time of Hippocrates, the first official outbreak dates back to Italy in 1494 (Verweij, 2007).

Initial treatments included experimenting with enough mercury or arsenic to kill the disease but not the patient; this mode of treatment led to the use of chemotherapy against cancer cells. In addition, the development of public health departments can be attributed to early attempts by medical researchers and officials to contain and control syphilis outbreaks.

(Hayden, 2003) Since then, researchers have identified three major stages of syphilis: primary, secondary, and tertiary; the illness can be difficult to diagnose since symptoms vary widely and in some cases no symptoms are present at all as the bacteria enter dormancy phases (NIH, 2009). Syphilis is caused by the spirochete Treponema pallidum; it is spread through broken skin or mucous membranes, most often as a result of sexual contact (Romanowski, 1997). However, there is also a congenital form in which the disease is spread from mother to child during pregnancy. T.

pallidum is a gram-negative bacteria with a helical shape and trademark corkscrew motility. It has very limited metabolic capacity, relying solely on glycolosis for survival. Although it requires very low oxygen levels, T. pallidum is difficult to culture in the lab as its limited metabolic capacity renders it highly dependent on a host. The complete genome was sequenced in 1998; however, this strain of bacteria is still mysterious and its virulence factor remains unknown.

(Baseman, Nichols, & Hayes, 1976) In the primary stage of syphilis, painless sores appear around the site of infection approximately two to twelve weeks after contamination. Even without treatment, the bacteria then enter a dormant phase and the sores disappear after two to four weeks. This period of dormancy, before the onset of stage two, can last up to two months. (NIH, 2009) The secondary stage of syphilis is highly contagious, as bacteria have spread to the bloodstream.

Symptoms of this stage include rashes of several possible forms: lesions on the palms or soles; mucous patches on the mouth, vagina, or penis; or warty patches on the genitals called condylomata lata. Additional manifestations of this phase can include fever, fatigue, irritability, hair loss, swollen lymph nodes, painful joints, or muscle aches. Once again, this stage ends and symptoms subside as T. pallidum enter a dormant phase, usually several weeks after phase commencement. (NIH, 2009) Late syphilis, or tertiary syphilis, is the final recognized stage.

It can follow the initial infection by up to fifteen years. If the disease is allowed to reach this point, chronic damage from bacterial infestation has spread throughout the entire body, often including the skin, nervous tissue, bones, eyes, arteries, and heart. These localizations of damage are known as gummas. This degree of progression often leads to permanent disability or death.

Complications vary widely depending on the organs affected -- they can include: aortic aneurysms, heart valve disease, heart infection, loss of hearing or vision, or syphilis of the brain (neurosyphilis). (a.D.A.M., 2008) Neurosyphilis has been speculated as the cause for eccentricites among well-known figures such as Henry VIII, Vincent Van Gogh, Adolf Hitler, Oscar Wilde, and Friedrich Nietzsche (McMyne, 2008). Oddly, some dementia caused by syphilis is preceded by a phase of mania and euphoria in which patients feel excitable and "high," often with relaxed inhibitions (Hayden, 2003).

In the United States today, syphilis rarely progresses beyond the first or second stage since treatment is widely available. Upon diagnosis, antibiotics such as penicillin or tetracycline are administered; follow-up tests must be performed at three, six, and twelve month intervals to ensure complete removal of the infection. Syphilis is always contagious, particularly in the first and second stages, so all sexual partners should be notified and treated as well. If treated during the primary stage, syphilis is completely curable with no risk of permanent health damage.

Unfortunately, initial symptoms may be mild and short-lived, so patients may avoid treatment out of ignorance, embarrassment, or oversight. (Vora, 1963) a vaccine for syphilis is currently under development and the outlook is positive (Cullen & Cameron, 2010). Despite near elimination ten years ago, syphilis infection rates are once again on the rise, particularly among black males and male to male partners. Since these findings indicate that issues of discrimination, poverty, and homophobia are involved, experts are pushing for government interventions to promote screening and treatment among young men at risk.

While syphilis among women saw a surge in the 1980s due to prostitution and cocaine use, female infections rates have been declining for the past several years. However, the Centers for Disease Control and Prevention (CDC) estimates an increase of nearly 40% in overall cases of syphilis since 2006. (Bonifield, 2010) in addition, between 2007 and 2009, an outbreak was reported among Native Americans in Arizona; 106 cases are documented from those years, including six cases of congenital syphilis. (Johnson, Urquidi, & al, 2010) Other outbreaks have been reported in areas of California,.