Recently I started re-watching The Borgias and, having reached the episode in which Juan (spoiler alert) reveals he has syphilis, I’ve found myself feeling nostalgic about my first ever degree-level essay. Which was about… Syphilis!
What is syphilis?
Hmm. Where to start? It is known by some as ‘the Great Imitator’, thanks to the diverse range of symptoms it produces in its victims. I’ll come back to those later.
Syphilis is caused by a gram-negative spirochete called Treponema pallidum. Basically, they’re spiral-shaped bacteria, with a complex cell wall structure. They look much like that in the image below – albeit much smaller and definitely not as fluffy…
It can be transmitted sexually or, less commonly, via blood transfusions or across the placenta from mother to foetus. The bacterium actually enters the body through either mucosal membranes, or via tears in the outer layer of the skin (epidermis).
From there, things get a tad more complicated…
When T. pallidum first enters the body, it creates a disguise for itself – in order to evade detection by the immune system. It cuts a molecule called fibronectin off the surface of mucosal cells and joins it to its own surface. This is helped by the fact that the bacterium can recognise a sequence of amino acids (the building blocks of proteins) found on the aforementioned fibronectin. What a coincidence!
There are several stages to the disease.
The first sign of primary syphilis is the formation of a chancre (pronounced ‘canker’; a kind of lesion) at the site of infection – this area is infectious for 3 to 6 weeks, before an apparently miraculous healing.
Secondary syphilis follows and is characterised by a non-itchy rash (generally on the hands and feet). This happens around 2 months after the canchre; the individual is at their most infectious during this time. Further signs at this stage of the disease are ‘condylomata lata’ (a fancy name for wart-like growths in warm, moist regions of the body – ew!) and ‘flu-like symptoms (e.g. fever, headache, enlarged lymph nodes).
With no treatment, the disease progresses to a latent stage – symptoms disappear, and it can last either for up to 2 years (‘early’) or more than 2 years (‘late’).
Tertiary (or late) syphilis is the final step for sufferers who remain untreated. This can present as soon as a year after infection, or up to 10 years – sometimes even decades! It takes the form of gummatous syphilis, neurosyphilis or cardiovascular syphilis. Basically, this means the disease will seriously damage the bones and/or skin, the brain or the heart.
Ultimately, all of this is a grisly, painful lead-up to death. Which is nice…
As it’s a bacterial disease, the first port of call is an antibiotic called benzylpenicillin – this should be injected into a muscle in the early stages of the disease. Other classes of antibiotic can be used but the courses will be longer. There is a risk of adverse effects, most notably the Jarisch-Herxheimer reaction: 24 hours of fever and extreme fatigue (the treponemes lashing out for the final time).
Aqueous benzylpenicillin (a water-based medication) is more effective in terms of reaching the central nervous system in the tertiary stage of the disease.
Oddly, only treatment in the late stage confers complete resistance to syphilis – early treatment could result in the patient catching the disease again! But I guess they’d have to be either seriously unlucky or very foolish for this to happen.
Cases of syphilis
There have been more patients diagnosed with syphilis in recent years (2,978 in the UK between 2011 and 2012), however it remains a relatively rare form of STD.
Throughout history, many notable figures have been rumoured to have suffered from the disease – such as Lenin, Vincent Van Gogh, Franz Schubert, Oscar Wilde and Napoleon Bonaparte. Others are known to have died of syphilis: Baudelaire, Al Capone, Gauguin, Scott Joplin and Guy de Maupassant.
So there you have it. Syphilis.