The Comeback of Syphilis

Public Heath England estimates that there is an over 70% increase in syphilis cases over the past 3 years. ‘Condom-less’ sex, the use of pre-exposure prophylaxis medication (PreP), multiple sexual partners, decreased awareness, and the wrong assumption that the disease is a thing of the past have all contributed to such a rise. (PreP is an HIV medication taken daily to prevent transmission from an infected individual to a healthy partner).

Syphilis is an infection that is mainly sexually transmitted, and is caused by a bacterium called Treponema pallidum. It is highly infectious, and on average there is approximately a 50% chance of getting the disease after sexual intercourse with an infected individual.

The History of Syphilis

The origin of the disease is largely unknown, and it is possible that the crew of Christopher Columbus brought it to Europe. The first recorded outbreak was in Naples all the way back in 1495, and in Europe it was coined a “French disease’ because it was spread by the French troops; but in Japan, for example, it was named a “Portuguese disease’. It has also been known as the ‘Great Imitator’, as it can mimic a lot of other illnesses.

Scientists believe that an early form of syphilis was much more destructive to the organs – especially the skin – than the modern type of syphilis. Literally, ‘the illness would eat the flesh from one’s face’, and certainly many medieval paintings depicting syphilis sufferers would typically paint a picture of a victim covered with pus-filled spots and having a severely disfigured face. Such people were ostracised from society as they were considered to be not only highly infectious, but also sexually deviant. A popular ‘cosmetic’ item of those times was an ‘artificial nose’ made of metal, as this was used to cover up a ‘missing nose’ in a syphilis sufferer.

Interestingly, the name ‘Syphilis’ comes from the name of a Greek shepherd Syphilus, who, according to legend fought the God of Sun, and as a punishment developed an illness that was to be known as Syphilis.

A few famous people were known to have suffered from syphilis – the painter Manet was believed to be amongst them.

Symptoms

Generally speaking, the symptoms of syphilis are:

• Swollen glands on the neck, groin or armpits
• A painless ulcer (called chancre) on the genitals, rectum, mouth (so-called ‘Primary Syphilis’)
• A red rash on the body, arms and feet (‘Secondary Syphilis’), which would normally develop a few weeks after, if the primary syphilis was left untreated.

One of the problems with syphilis is that often it causes no symptoms, and affected patients may not know that they have the illness.

The bacteria can remain in the body for many years (although occasionally the body does clear it) and eventually may affect other organs- like the heart, eyes and the brain. This is known as Tertiary syphilis. Therefore an early diagnosis and treatment is essential to prevent the disease from spreading.

Diagnosis

The easiest way to diagnose syphilis is by taking a swab from an ulcer; however it is not always possible and most diagnoses are made from a blood test.

A carefully taken history of a patient’s exposure to syphilis is paramount in this case. Even then, the diagnosis of syphilis may not be straightforward, and sometimes a few samples over a course of few weeks are needed, and more than one method is often used to reach the diagnosis.

• The first test used measures an antibody called IgG/IgM through a process called EIA. This test will give an accurate result 1-2 weeks after exposure to syphilis.
• If the EIA is positive, then a laboratory will use two other tests called TPPA and RPR, in order to differentiate between the types of Treponema bacteria.

Treatment

The first available treatment for syphilis was the metal, mercury. It remained to be one of the most effective treatments for the disease up until the late 19th century. Mercury was either rubbed into the skin or inhaled, with the resultant side effects of the treatment often being worse than the disease itself!

As the disease became better understood, other treatments became available. One of them was a solution containing a poison, arsenic, which not surprisingly caused many negative effects, often including death.

Then, in the early 20th century, it was noticed that if a high fever was induced in syphilitic patients, it would often cure the disease itself. Thus, they started to use malarial organisms, which, after being inoculated to syphilis sufferers, would cause fevers and shivers. There is no medical data to show how effective such treatment was overall for curing the syphilis. However, there was at least an effective treatment for malaria at that time- Quinine. Such patients would then be administered this medication to clear the malaria from the body.

With the discovery of Penicillin, such treatments became unnecessary and Penicillin remains to be a drug of choice when treating Syphilis until now.
The form of the Penicillin used is called Benzathine Penicillin. A single injection in to a muscle allows a slow release of the antibiotic in to the system over a course of 2-4 weeks. Syphilis patients may require more than one injection to ensure that the infection clears from the body. The injection is very expensive and it is mostly imported to the UK from abroad.

There are other antibiotics that are now becoming an acceptable medication of choice like Doxycycline and Azithromycin. They come in a form of tablets and need to be taken over a course of few weeks on a daily basis. These antibiotics are not without unpleasant side effects. For example, Doxycycline can cause severe indigestion and Azithromycin often causes nausea and stomach pains.

In summary, syphilis remains to confer a significant burden on our modern society. Although it can’t be always prevented, the risk of contracting it could be reduced by using condoms during vaginal, anal and oral sex, minimising the number of sexual partners and avoidance sharing sex toys.
These measures would also reduce the risk of catching other sexually transmitted infections (STIs). Regular testing for syphilis and other STIs if one is at risk is important for an early diagnosis and a successful treatment.

At ROC Clinic we are able to perform all types of tests in order to identify the illness. If you have any concerns about your sexual health and wish to discuss these with us, do get in touch.