Syphilis what is its origin

Beck describes a typical mercury treatment :. The massaging was done near a hot fire, which the sufferer was then left next to in order to sweat. This process went on for a week to a month or more, and would later be repeated if the disease persisted. Other toxic substances, such as vitriol and arsenic, were also employed, but their curative effects were equally in doubt.

Treatment would typically go on for years and gave rise to the saying,. Ammoniated and salicylated mercury ointments were developed and the pharmaceutical formulae for unguentum hydrargyri ammoniate and unguentum hydrargyri salicilate were still in the Australian Pharmaceutical Formulary in When it was realised by physicians that the toxic effects of mercury often outweighed any benefits it might have had, they looked for alternatives. The Polish surgeon-general Friedrich Zittman mixed a drug consisting of the root of sarsaparilla with traces of mercury and called his elixir Decoctum Zittmani.

The English surgeon William Wallace introduced iodine therapy, potassium iodide with small doses of mercury.

In the late 19th century various other metals such as tellurium, vanadium, platinum and gold were tried but were not effective. He had been experimentingfor some years with the use of arsenic compounds in treating trypanosomiasis.

Ehrlich then began experimenting with arsenic compounds in treating syphilis in rabbits. In Ehrlich was awarded the Nobel Prize for his discovery. In , A. Robert and Benjamin Sauton discovered the trypanocidal properties of bismuth, and in , Robert Sazerac, Constantin Levaditi and Louis Fournier successfully treated syphilis with bismuth.

Arsenic, mainly arsphenamine, neoarsphenamine, acetarsone and mapharside, in combination with bismuth or mercury, then became the mainstay of treatment for syphilis until the advent of penicillin in The observation had been made that after a febrile illness the symptoms of neurosyphilis diminished, and the rationale was that it was easier to treat malaria with quinine than the syphilis with mercury or arsenic. Fred A. Kislig and Walter M. Simpson, two American physicians, introduced in the treatment of electropyrexia, using a short-wave apparatus to induce pyrexia in a patient to treat syphilis and gonorrhoea.

This became a turning point in the treatment for syphilis as penicillin was shown to be highly effective when administered during either its primary or secondary stages, and it had few side effects of any significance when compared to mercury or arsenic. Arnold wrote in of his early work with penicillin and syphilis:. Before the introduction of penicillin, the heavy-metal cure often caused thousands of deaths each year.

The morbidity and mortality of the disease itself was horrendous, involving all ages from the fetus to the elderly. Over the past five centuries, and particularly in the last century, the origins of syphilis have caused great controversy amongst historians, physicians, anthropologists and palaeontologists.

A recent analysis of the evidence however by Kristin N. Harper, George J. The Columbian hypothesis that syphilis was brought to Europe from America in was reaffirmed in the s and s by a number of historians and physicians such as Harrison , Dennie , Goff , and Crosby Garrison [11] refers to a publication by Karl Sudhoff , a German medical historian from the University of Leipzig, who stated that the Naples epidemic was typhoid or paratyphoid fever.

The article also cited Butler as stating that historical evidence of aortic aneurysm being treated by Antyllus, a contemporary of Galen in Romans times, was evidence of the existence at that time of syphilis, and that Celsus accurately described a genital syphilitic chancre.

The evidence suggests that the disease existed in both hemispheres of the world from prehistoric times. In the last several decades development of palaeopathology has enabled close evaluation of Old World skeletons and many studies have published their findings of evidence for syphilitic bone disease. Rothschild published a review of the historical and palaeopathological record of syphilis. Rothschild found that the pathological osseotype features of syphilis were absent in human specimens from re-Columbian Europe, Africa and Asia.

However specimens with evidence of treponeal disease were identified from North America dating back some 8, years. Bruce Rothschild as co-author with Christine Rothschild in their review study in found that somewhere between and years ago the first identified osseotype evidence of syphilis occurred in North America and it appeared that syphilis had transmutated from yaws.

Rothschild also states that all evidence for treponeal disease existing in re-Columbian Europe represents isolated cases for which alternative diagnoses are more likely. They also stated that the rapid spread of syphilis throughout Europe around reflected the introduction of a virulent disease into a population that had not been previously exposed and had no immunity to it. The authors concluded that among the 54 reports they evaluated using their criteria they did not find a single case of Old World treponeal disease that had both a certain diagnosis and a secure pre-Columbian date.

They came to the overall conclusion that evidence for an Old World origin for syphilis remains absent, and that this further supported the hypothesis that syphilis, or its progenitor, came from the New World. Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you.

The origin of syphilis is still a topic of debate and research, believed by physicians and scholars up until early last century to have been brought to the Old World from America by Christopher Columbus. In recent times, archaeologists and palaeontologists had found possible evidence it existed in the Old World before Columbus. This has been disputed by other researchers however and it seems that it is still possible that Columbus did bring syphilis, or its progenitor, to the New World.

Submit your article First felt strange pains, and sleepless passed the night. From him the malady received its name. Author Information. References 1. Rolleston JD. Venereal disease in literature. Brit J Vener Dis ; 10 3 : History of U. Military Medicine ; April Suppl : Venereal Diseases. Editors Internal Medicine in Vietnam.

Vol II. General Medicine and Infectious Diseases. Ackerknecht EH. A Short History of Medicine. Revised edition. Baltimore: John Hopkins University Press, 5. Karlen A. Man and Microbes. These writings allow us to travel back in time to get a glimpse of how this disease has affected humanity over the past years. Despite our desperate attempts to fend off syphilis over the past few centuries, the disease keeps rearing its ugly head throughout the world.

Penicillin G, aka "the Silver Bullet," which was and still is an effective treatment for syphilis especially for primary, secondary or early latent infections , was discovered about 30 years after the story above was written. The disease should be nothing to worry about by now in the U.

However, for the past decade, the incidence of syphilis in high-income countries, including the U. Primary and secondary syphilis rates in the United States by region, The U. To add insult to injury, the Center for Disease Control and Prevention CDC 's effort to eliminate syphilis ended in December due to lack of funding that unfortunately coincided with a sharp increase in disease incidence. In , the rate of reported primary and secondary infections was 9.

The increase in primary and secondary infections could be due multiple factors, including an increase in pre-exposure prophylaxis PreP usage and the effectiveness of antiretroviral therapy among HIV-infected individuals, both of which could lead to increased condomless sex among men who have sex with men MSM.

Reported cases of congenital syphilis in the U. Despite the recent increase in reported cases of congenital syphilis from all over the U. Humans have had a long and complicated battle with syphilis, a disease once supposedly described by Sir William Osler as the Great Imitator due to clinical presentations in its late stages simulating " almost every disease known to man.

Dark field micrograph of T. For all human treponematoses, the initial infection usually occurs following an exposure of mucosal surfaces or traumatized skin to bodily fluids containing pathogenic treponemes. After initial invasion beyond the epithelia or mucosal membrane, the organisms multiply and disseminate hematogenously or via lymphatic systems.

Endemicity or geographical distribution of these diseases are quite different. While syphilis is globally distributed, endemic treponematoses are naturally usually observed in certain regions of the world. For example, yaws is endemic in equatorial regions. Although there is overlap in clinical manifestations, each human treponematosis has some distinguishing characteristics.

Yaws is mainly a disease of the skin, joints, soft tissue, and bone, transmitted by skin-to-skin contact with no evidence of vertical transmission. Initial papillomatous lesions usually occur in the lower extremities and subsequently develop into ulcers. Late stage central nervous system CNS complications are rare, but if left untreated, severe destructive osteitis resulting in permanent deformity may occur.

On the other hand, syphilis is sexually transmitted in general, with well-characterized vertical transmission, and when left untreated may result in late stage complications in many organ systems including the CNS. There is still debate over the origin of syphilis and how it spread to different parts of the world. Furthermore, controversy raged as to whether syphilis was caused by a specific trepomene e. Clarification of this question—and, therefore, of the origin of syphilis—has been complicated because of the diagnostic vagueness of the historical written record [ 1 , 6 , 7 , 57 , 58 ].

Laboratory analyses have not been helpful. Metabolic, histologic, microbiologic, immunologic, and even sophisticated DNA techniques have failed to distinguish between yaws, bejel nonvenereal syphilis , and venereal syphilis [ 45—47 ].

The unanswered question in DNA analysis, however, relates to the choice of genome chosen for analysis. Although DNA analysis has allowed confident confirmation of the diagnosis of treponematosis, distinguishing among the treponemal diseases still eludes us.

Given that the T. Syphilis, as one form of pathologic treponematosis, has a skeletal signature. It alters the appearance of bones in a highly specific manner, which one can find if one knows how to look [ 20 , 21 ]. The peculiar skull radial scarring and sabre shin alterations appear to be specific for treponematosis, but such findings do not allow one to distinguish among the types of treponematosis, and use of periosteal reaction has limited specificity.

The special skeletal appearance of syphilis, however, is recognizable as a population phenomenon. Pre-Columbian evidence of treponemal disease abounds in cemeteries in both the New and Old World [ 8—15 , 56 , 61—69 ], with diagnoses given for what were perceived to have been isolated individuals with periosteal reaction.

Population analysis, however, provides an opportunity to confidently distinguish among the treponematoses [ 19 , 20 ]. Treponematoses are rather readily recognized as a population-based phenomenon on the basis of what percentage of the population manifests the condition.

Although pinta has been referred to as a separate disorder with pathology limited to the skin, review of the literature about pinta actually revealed the presence of bone involvement due to pinta to be no different from that due to the endemic treponeme found in the same area [ 70 ].

Infantile cortical hyperostosis i. Caffey disease affects the jaws and clavicles of children—areas that are unaffected by treponemal disease [ 25 , 73—75 ]. Thyroid acropachy is a disorder localized to the distal skeleton hands and feet and is quite distinguishable from the tibial predilection of syphilis [ 25 , 76 ].

Hypertrophic osteoarthropathy is a predominantly intrathoracic disease—related polyostotic disorder with a unique predilection. It never affects the proximal diaphyseal region of the tibia unless the distal portion is also affected [ 32 ]. Examination of skeletons from populations with one documented treponematosis allowed identification of diagnostic criteria for distinguishing among them [ 20 ].

Indicatesa degree of remodelingsuch that there isno longer any surfaceevidence of periosteal reaction. Tibia e ,fibula e , and femora e , etc. The autopsy-documented Hamman-Todd skeletal collection Cleveland Museum of Natural History, Ohio provided an opportunity to characterize the skeletal manifestations of syphilis [ 20 , 21 ], with neurosyphilis and cardiovascular syphilis providing comparison groups.

Because bejel has been documented as the only treponemal disease present among the eastern Mediterranean Bedouin [ 16 , 17 , 78—80 ], examination of cemeteries dated — a. Similarly, yaws was documented as the only treponemal disease present in the region before [ 1 , 81 , 82 ]. Examination of these populations revealed some shared characteristics and some that reproducibly distinguished among the treponematoses. Periosteal reaction figures 1 and 2 is the primary osteologic clue, but variety figures 3—6 of periosteal reaction e.

Similarly, gumma and stellate frontal bone scars do not differ in character or frequency among these populations. Criteria unique to syphilis were the frequency of osseous involvement in the population and the extent of remodeling of the characteristic sabre shin lesion [ 20 , 83—85 ]. These frequencies and osseotype characteristics are independent of sex and ethnicity [ 4 , 26 , 32 , 50 , 51 ]. Although sabre shin occurs in all forms of treponemal disease figure 7 , only in syphilis can sufficient remodeling occur to hide all surface signs of periosteal reaction figure 8.

Syphilis is pauciostotic the mean number of affected bone groups was 2 , and hands and feet are rarely affected. This contrasts with polyostotic involvement in yaws, for which there is frequent hand and foot involvement.

Lateral view of midportion of tibia showing sabre shin with residual surface periosteal reaction. Lateral view of tibia showing sabre shin with total remodeling of surface bone. Although tooth-related and congenital manifestations appear to be specific to syphilis, the occurrence of these conditions and the preservation of materials in the archeologic record are so infrequent as to preclude population comparisons [ 86—88 ].

Alterations at the epiphyseal line are extremely rare [ 89 ] and would be identified only if the affected individual had died prior to the routine bone remodeling that erases all evidence of congenital disease over the course of several months of growth [ 90 ]. Although Dutour and colleagues [ 5 , 91 ] reported what they thought was a case of syphilis from medieval France, the case occurred in a lithopedian with calcified membranes and did not actually have the requisite periosteal reaction.

The osseotype characteristics of syphilis are absent in specimens from pre-Columbian Europe, Africa, and Asia [ 61 , 91—93 ]. Somewhere between and years ago, the first identified osseotype of syphilis occurred [ 49 ].

The Mogollan Ridge proved to be the dividing line with respect to both the first appearance of syphilis and the climatic change that may have been responsible for the event [ 93 , 94 ]. Its osseous signature is recognized to have occurred years ago in New Mexico, years ago in Wisconsin, years ago in Ecuador, years ago in Florida, and years ago in Michigan and West Virginia [ 49 ].

It is clear that syphilis was present in the New World at the time of Columbus' arrival [ 19 , 49 ]. Especially pertinent is documentation of syphilis in the area where he actually landed, the Dominican Republic [ 95 ]. The average number of bone groups affected ranged from 1. Sabre shin remodeling was often so marked as to erase all surface indications of periosteal reaction. The osseous evidence documents the presence of syphilis in the Dominican Republic where Columbus landed.

Columbus' crew clearly had the opportunity and means to contract and spread the venereal disease we now call syphilis. Appreciation is expressed to unnamed reviewers whose cogent queries directed appropriate clarification in this manuscript.

Financial support. The Arthritis Center of Northeast Ohio. Potential conflicts of interest. Google Scholar. Google Preview.

Posterior views of radius, ulna, and tibia showing ulnar bowing, ulnar draining gumma, and tibial periosteal reaction. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract.

Actual Recognition of Disease. Treponemal Disease in Europe. Origins of Treponemal Disease. What is History? Literary Record. Evidence-Based Analysis. Distinguishing the Treponematoses. Skeletal Criteria. Origin of Syphilis. Figures and Tables. History of Syphilis. Rothschild Bruce M. Oxford Academic. Cite Cite Bruce M. Select Format Select format. Permissions Icon Permissions. Abstract Evidence-based research now allows clear separation of syphilis from other diseases in its class of treponematoses.