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Chapter 12

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Health Studies
Rhan- Ju Song

October 2012 The Great Pox Syphilis  Men were not told they had syphilis they were told they had “bad blood”  The Tuskegee study was designed to document the natural history of syphilis. But it came to symbolize racism in medicine, ethical misconduct in medical research, paternalism by physicians, and government abuse of society’s most vulnerable—the poor and uneducated A Look Back th  In 1996 the 500 anniversary for the arrival of syphilis in England was “celebrated”  It was said that this disease was brought to Naples by the Spanish troops  The French called the pox the “disease of Naples”, Italians “ The French Disease”  Victims of syphilis suffered with fevers, open sores, scars, pains in the joints, and gruesome deaths  Two main theories o Columbian: o Pre-Columbian:  It was a new disease introduced into a naïve population and that the increased rate of transmission by sexual means transformed what once had been a milder disease into a highly virulent one  Another reason why there was a rapid spread was because precautions against transmissions were not observed  Treatments with the Great Pox varied with the times  In Italy they tried mercury for the treatment o Mercury was applied topically to the suppurating sores, or it was taken in the form of a drink “salivation”  Port cities with their characteristics of high sexual activity and prostitution provide the locale for the possibility of high transmission rates of sexually transmitted diseases Spirochete Discovered  Early observers believed that syphilis was God’s punishment for human sexual excesses  Girolamo Fracastoro recognized that the disease was contagious, and he called it syphilis after a fictitious Shepard name syphilis, who got it by cursing the Gods  Fracastoro described the earliest stages of syphilis as small ulcers on the genitals, followed by a skin rash  Fracastoro theorized that syphilis was a result of “seeds of contagion”  In 1905, Fritz Schaudinn and Erich Hoffmann identified a slender, spiral shaped bacterium, a spirochete in the syphilitic chancres  They called the microbe Treponema and because it stained so poorly they named its species pallidum o Human beings are the only natural host for Pallidum o It divides slowly and quite fragile, requiring a moist environment  One of the reasons it took so long for microbe hunters to identify the cause of syphilis was that it was confused with another venereal disease, Gonorrhoea The Disease Syphilis  Disease such as syphilis were called “venereal diseases”, transmitted by sexual contact, now referred to as STDs 1 October 2012  Syphilis has been called the “ Great Imitator”  The chancre state is the earliest clinical sign of disease after 21 days after initial contact, a painless pea-sized ulcer (chancre) appears at the site of spirochete inoculation o Chancre is a local tissue reaction that can occur on the lips, fingers or genitals  The infection can spread by kissing or touching a person with active lesions on the lips, genitals, or breasts  If untreated the chancre usually disappears within 4 to 8 weeks. Leaving a small inconspicuous scar  The secondary stage usually develops 2 to 12 weeks after the chancre stage o T. pallidum is present in all the tissues especially in the blood o There is high levels of syphilis antigen o Headache, sore throat, mild fever, skin rash o The highly infectious secondary stage does not last very long  The early latent stage o He/she appears to be diseased free, there are no clinical signs, it is the most dangerous time o Infected individuals can still infect to others  The infection continues to progress and after about 2 years the latent stage develops  Tertiary syphilis develops in 1/3 of untreated individuals o Disease becomes chronic o Destructive ulcers appear on the skin, muscles, liver, lungs, and eyes Catching Syphilis  At the primary chancre stage. Syphilis can be spread by kissing or touching a person with active lesions on the lips, genitals or breasts  During the secondary stage. Which usually does not last very long, the skin lesions render the individual infectious  In the early latent stage, there are no clinical signs, however the individual remains infectious  Syphilis can be transmitted from the mother to the developing fetus via the placental blood supply, resulting in congenital syphilis  Infants who are the offspring of the congenitally infected may have Hutchinson’s triad: deafness, impaired vision, and weird teeth The Pre- Columbian Origin of Syphilis  All of the treponemes that cause the human diseases yaws, pinta, and syphilis are identical in their morphology and differ very little genetically  The Treponema family of spirochetes forms the basis of the theory of a pre- Columbian origin of syphilis o Theory suggests that human traponemes may have come from animals and that an infection similar to pinta localized in the skin, arose about 15000 bc in Africa and then with human migration passed across the Bering Straits to become isolated in the tropics of the Americas, places where the humidity is high  Pinta is restricted to the skin, is disseminated by introduction into skin lesions, and is usually found in persons 15 to 30 years of age o Pinta is found in tropical Central and South America where hygiene is poor a
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