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18 Apr 2012

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Syphilis “Great Pox”, Cupid’s disease, The Black Lion, Lues,
-aka Other terms: Morbus gallicus, French/Italian/Spanish/Polish/Christian/British/Cupid‟s* Disease, Great Pox, lues (venerea), The Black Lion, The evil
pox (*Grandgore in Scotland)…related to who was discriminated, symptoms
-associated w/ discrimination vs. marginalized society e.g. poor, uneducated, immigrants, diff. sexual orientation
-1494: Naples invasion -King Charles VIII of France invades Italy, at same time, outbreak of new epidemic in Naples. Following yr, mysterious affliction
reported in England, France, Germany rest of Europe World . This time (15th C) coincides w/Colombus‟ return from New World to Europe. call it
“Naples disease”, Neapolitans call it “French disease”….Debate: Columbus‟ voyage or Naples Invasion?
-Giovanni de Vigo- wrote Pamphlet of syphilis (A Fine Treatise on the Origin of the French Evil)
-“Syphilis” -1530 Girolamo Fracastoro‟s (Venetian Dr) poem Syphilis sive morbus gallicus -shepherd Syphilis cursed God, punished w/disease.
-Famous ppl who got tertiary syphilis that led to insanity Henry VII, Hitler, Lincoln, etc
-Hippocrates/Galen made no mention so apparently no presence in ancient Greece or Roman Empire
-Note : STDs formerly known as „venereal disease‟ (VD) named after Venus, Goddess of Love
Theories (undecided) (258-260, 265-266, kiple 2000-2007) - From Columbus‟ voyage or Invasion of Naples
1) Colombian Theory- Intro‟d to Europe from New World, Evidence: records (bone lesions), skeletal remains fr. Americas, pattern of spread
2) Pre-Colombian / Anti Colombian Theory based on Treponema family
Unitarian vs. non-Unitarian theory.
Unitarian -phenotypically same, small genetic differences…All come from one treponeme and wud change dep. on environment vs.
Non-Unitarian related strains occurred b/c of successive mutations e.g.(15 000BC Africa) pinta mutated yaws endemic syphilis (not std) venereal
syphilis (std) (1500s), 15th c mutation made it really virulent in Europe; AfricaMediterranean Europe…Evidence: Many Native Americans decimated
by syphilis in 16th C after European arrival
Modern History what we base our knowledge on
-John Hunter (1728-1793-Founder of Scientific Surgery; a confused man…) undertook flawed self-experimentation (injected himself w/ wet (gonorrhoea)
form!). Dvlped signs of syphilis, concluded two infections (wet & dry) were the same = WRONG. Eventually died of heart problem (tertiary syphilis).
confused about venereal syphilis (dry) and gonorrhoea (wet)
-Philippe Ricord (1799-1889) demonstrated that gonorrhoea & syphilis were different diseases. Determined 3 stages of syphilis: prim/sec/tertiary.
-Rudolph Virchow (1821-1902) established that syphilis was spread via blood.
-1905: Shaudinn & Hoffman discovers germ agent: spiral-shaped bact, spirochete, “Treponeme pallidum” (corkscrew+thread+pale)
2 main perspective studies to learn natural history of Syphilis
-Oslo‟s study surveyed primary/secondary syphilis patients diagnosed, immunologic tests
-Tuskegee study (1930s) today: symbol of racism, symptom-based, poor, uneducated African-Americans recruited, given incentives (free burial, exam)but
never told what they had, had latent syphilis, denied access to treatment, unethical method of research. By the time the study was made public,
men/women/kids died President Clinton‟s apology on behalf of US Gov.
-Causative agent: Treponema pallidum. Fragile spirochete, surviving briefly outside host, needs moist environment, no particular climate, can‟t be cultured,
can be grown in some animals (rabbits, guinea pigs), but Only natural host is a human..
-Ro = 3?
Transmission STD direct, ppl-ppl via (sexual)contact w/sores, open lesion, utero/transfusion of infected blood. “Great imitator” b/c many signs/symptoms
similar to others.
-Rapid transmission due to sex (amplified mild disease highly virulent), no precautions against transmission, mouth-mouth kissing, shared drinking cups,
early stages (chancre/rash) considered minor, self-healing, for STDs in gen: (crack-cocaine) prostitution, homosexuality, immigration, urbanization, changes
in social habits, clothing, sharing eating utensils, hygiene, poverty
Related Human Treponematoses diseases (note subspecies)
Yaws skin/bones, T. pallidum pertenue (subspecies), humid tropics
Pinta skin, T.pallidum carateum, Central/South America
Endemic syphilis- sim. to yaws, but warm/arid climates, T. pallidum endemicum, not std, same clinical manifestations of syphilis
Venereal syphilis- T.pallidum pallidum (yes x2!) std, no specific climate, affects any tissue/organ
- Congenital syphilis fr. mother to unborn fetus via placenta
- ~12M cases/yr worldwide. 1920s: 9,000 death rate in US, 60,000 born infected. 1940: 13,000 annual deaths. 1949: 6,000+ deaths. 1970: .2/10,000 deaths.
2002: over 32,000 cases 1997: 4x as many cases in Canada.
-Worldwide (1999): highest incidence in Sub Saharan Africa, South&SouthEast Asia, Latin America/Caribbean, North Africa, W.Europe...
-Gender difference- male to female ratio 2.6 : 1
-Spatial difference provinces of Canada vs. British Columbia (so much higher) - associated w/ sex trade in downtown BC
-Congenital Syphilis scariest transmission to infants <1yrs old (change in surveillance case definition of cong. syph led to what seems to be a peak, but it
was just an acknowledgment of what already existed); prevalence of syphilis in pregnant women in Latin America & Carribean= high concern
-American South African-American men, due to poverty, inadequate access to health care/treatment, prostitution, lack edu, homosexuality
Epidemiological Triad and factors
Host human e.g. antibodies, clothes
Agent- Treponema pallidum e.g. resistance,
Environment physical & social e.g. increasing skin moisture creates new portals of entry
Clinical Manifestations
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