Where does Syphilis come from and How does Syphilis spread?

The Italians call it the French disease; the French call it the English disease. Russians blamed the Poles, the Poles blamed the Germans.

At least since the sixteenth century, Europeans have been blaming each other, if it isn’t English, French, Polish, Russian, or German, then it’s Venetian or Neapolitan. Some believe Columbus brought it back to Europe from the New World. No one really knows definitively where it came from, but everyone agrees on this: syphilis certainly didn’t come from us.

Some believe that syphilis has existed in Europe since antiquity, but that it had always been mistaken for leprosy or some other disease. But confusion reigns, because the best definitive descriptions of the disease in Europe date only from about 1500, and there is no way to know whether this is because it was a newly imported disease or because medical knowledge had progressed to a point where a clear description of the illness was possible. It is probably best to leave aside the question of who should take “responsibility” for the existence of a bacterium, but the question of the origin of syphilis, as of any disease, is nevertheless of some interest.

Even the latest theory, supported by evidence from the analysis of skeletal remains, hasn’t settled the question. Two paleopathologists, Bruce and Christine Rothschild, have concluded that evidence from bones proves a New World origin. They examined several hundred human skeletons from sites in the United States and Ecuador and claim to have shown that southern skeletons (from New Mexico, Florida, and Ecuador) show evidence of syphilis infection, and that the disease has existed in the New World for at least 800 and possibly as long as 1,600 years.

That would mean that someone who had visited the western hemisphere may have brought it back to Europe with him. Yaws is a disease caused by a closely related bacterium, and some now suggest that the Treponema pallidum that causes syphilis is a genetic mutation of the yaws bacterium, T. pallidum subspecies pertenue. But others, citing evidence of syphilis in European skeletons as old as 1,700 years, dispute the Rothschilds’ conclusions and still believe that syphilis originated in the Old World, or perhaps in both hemispheres simultaneously, and that Columbus had nothing to do with its presence in Europe, where it had been endemic for centuries.

Whatever its origin, it is clear that there was a significant syphilis epidemic in Europe in the early sixteenth century, and the earliest definitive descriptions of syphilis in Europe date from that era. The infection was probably spread widely by soldiers and their camp followers, and it was known even at that time that the disease was sexually transmitted.

By 1530 it had received its name, taken from the shepherd hero of a Latin poem written by an Italian, Girolamo Fracastoro. Fracastoro was a physician expert in contagious disease, a professor of logic, an astronomer, a geographer, a botanist, and a poet (a Renaissance man, both literally and figuratively) who in 1546 published a book entitled De contagione et contagiosis morbis et curatione (On Contagion, Contagious Disease, and Its Treatment), which assured him a lasting place in the history of epidemiology. But the work for which he is perhaps best remembered is another medical treatise, this one published as a long poem called Syphilis sive Morbus Gallicus, which translates into English, predictably, as “Syphilis, or the French Disease.” Syphilis is the name of the shepherd hero of the piece.

For centuries, doctors assumed that syphilis and gonorrhea were the same illness, but in 1837 a French physician, Paul Ricord, showed that they are caused by two different organisms. He also distinguished the three different stages of syphilis infection. Rudolph Virchow discovered that the infection could move through the blood to internal organs, and by 1876 cardiovascular syphilis had been clearly documented.

Syphilis epidemics occur periodically in various parts of the world, and blaming others for them has been the standard response. In 1862, Arthur B. Stout, a doctor prominent in the American Medical Association, published a fuzzy-brained report called “Chinese Immigration and the Physiological Causes of the Decay of a Nation,” in which, with no scientific evidence whatsoever, he accused Chinese immigrants of bringing syphilis into the United States. Such reports were quickly taken up by nativists in Washington eager to codify their bigotry by imposing strict restrictions on Chinese immigration. Later, Italian immigrants would take the rap for T. pallidum. Jews and Irish Catholics, no immigrant group is left out when it comes to this kind of bigotry, were usually blamed, respectively, for tuberculosis and cholera in the early part of the twentieth century.

In 1994, there were 2,435 cases of congenital syphilis reported in the United States, the height of an increase that had begun in the mid-1980s. By 2000, the number of cases had declined to 529. No one is quite sure why this decline happened, but it may have been connected to publicity for AIDS prevention encouraging safe sex, which had the effect of reducing other STDs as well, particularly among men who have sex with men, which was the population most at risk for the illness in the 1980s and 1990s.

In any case, in 1999 syphilis rates increased for the first time in 10 years to 130 cases. There were 117 cases reported in 2000. In the first six months of 2001, there had already been 115 cases reported. Some have suggested that this may also be connected to the (irrationally) reduced worry about AIDS transmission and the corresponding inattention to safe sex practices among populations at risk. These increases are troubling. Syphilis and AIDS tend to travel together, and people with syphilis have an increased likelihood of acquiring and transmitting HIV because of the genital ulcers that break the skin. Many urban areas, including Los Angeles, San Francisco, Seattle, and Philadelphia, have seen an increase in syphilis among men who have sex with men, and the disease has persistently high rates in rural areas, particularly in the Southeast.

Syphilis is caused by a spirochete, the spiral-shaped bacterium T. pallidum, and it is transmitted during vaginal, oral, or anal sex, and more rarely by kissing or close skin contact. Pregnant women can pass it on to their newborn babies. You can’t get it from toilet seats, doorknobs, swimming pools, or hot tubs, or from sharing eating utensils or clothing.

An average of about three weeks after infection a sore called a chancre appears in the genital area or wherever syphilis first entered the body. In its earliest stages, it isn’t possible to diagnose syphilis by a blood test. You have to actually see the spirochetes under a microscope in a sample taken from one of these sores. The chancre is usually small and round, and it doesn’t cause any pain. Then it heals on its own within a month or two. But this is not the end of the story.

If you don’t get treatment during this period, the disease goes into its secondary stage. This starts with a skin rash that appears either as the chancre is going away or up to several weeks after it disappears. The rash, red or brown, can appear anywhere on the body and has a particular predilection for the palms of the hands and the soles of the feet. It doesn’t hurt or itch. You can also get fever and swollen lymph nodes during this stage, and a sore throat, headaches, hair loss, tiredness, or muscle aches. You are infectious when there are symptoms, either in the first or second stages. This rash clears up on its own, even if you don’t get any treatment, but there is still more to come.

Syphilis doesn’t go away just because the secondary stage symptoms have disappeared. Instead, it lurks in the body during what is called the latent, or hidden, stage of the disease. The virus lives on and antibody tests for it are positive, although there are no active symptoms.

It can still be treated at this point with penicillin, but if it isn’t treated, about 50 to 70 percent of infected people progress to tertiary syphilis. This is the stage that causes death due to complications in the skin, bones, central nervous system, heart, and blood vessels. The lesions recur at this stage and can be present for vastly varying periods of time, from as little as two years to as many as 40 years from the onset of the infection. When the lesions occur on the heart, brain, or liver, they can destroy the functioning of those organs and cause death.

Neurosyphilis, that is, disease that affects the central nervous system, causing eye or hearing problems, cranial nerve palsies, or symptoms of meningitis (brain inflammation), can occur at any stage. It is treated with penicillin and requires an examination of the spinal fluid every six months to look for evidence of disease activity. If there are antibodies still present after two years, then retreatment has to be considered.

If a pregnant woman has syphilis, her fetus can be infected in the womb, and the baby can be born with syphilis. Most infected babies have no clinical evidence of disease at birth, but soon develop a runny nose and a widespread rash.

Treatment involves consideration of the mother’s health status and what treatment she received during pregnancy, it requires careful follow-up and serologic testing, and it depends on careful diagnosis of the infant.