Origins of Syphilis: How the STD Began

Abstract 

Syphilis has for a long time been thought to be a disease of the early days. However, the rates of infection are still very high in certain countries. Several types of research have been conducted to investigate history, prevalence, treatment options and the cost as well as cost-effectiveness of diagnosis. The main purpose of this paper is to discuss the history of syphilis, its prevalence, its diagnosis and cost effectiveness in treatment. One result of the research indicates that the prevalence of syphilis is high in female workers who do not use prevention measures. Also, it indicated that antenatal programs are cost-effective especially for expectant mothers. Also, it showed the type of treatment physicians’ use in treating syphilis. The findings presented in this research paper will be helpful to national programs especially in identifying the prevalence of syphilis and finding the most effective measures to prevent and manage the spread of the disease. 

Introduction 

Syphilis is a common sexually transmitted disease caused by bacteria known as Treponema pallidum. It contains similar symptoms as those of other diseases such as pubic lice, genital warts, and other sexually transmitted infections. It is a common disease to people at the age of 20 and 39 years of age. In the year 2006, nearly 36,000 cases of this disease were reported in more than twenty countries. Its infection is high in women at the age of 20 to 25 years and men at the age of 35 to 39 years (Hoeger & Hoeger, 2008). The most common way that syphilis is contracted is through sexual contact. The symptoms of syphilis are categorized in three stages. In the first stage, one experiences little sores for about 6 to 10 days, and they can heal without medical attention (Warell, Cox and Firth, 2012). However, this may advance in the second stage if one does not seek medical treatment. In the second stage, one experiences irritation of the skin and rashes start to develop (Warell et al. 2012). These rashes are usually not itchy, but one appears small red or brown bumps in various parts of the body. If one does not seek medical attention at this stage, one will reach the final stage whereby the symptoms are severe. Some of the symptoms in this stage are dementia, numbness, difficulty in muscle coordination and blindness (Warell et al. 2012). 

History of syphilis 

Historically, syphilis has been given many names. It was named after an enemy country believing that the country was the cause of its existence. For example, the French would call it the Neapolitan disease while the Italians would call it the French disease or the French pox (Frith, 2012). The name “syphilis” originated from a poem known as sive morbus gallicus published in 1530 by Girolamo Fracastoro. He described its symptoms and treatment with the use of guaiacum herb which was made from the back of trees and the use of mercury (Frith, 2012). According to the article Syphilis - Its Early History and Treatment Until Penicillin, and the Debate on its Origins by Frith John, Johannes de Vigo, an Italian surgeon wrote that this disease instigated from having sexual contact with an ill person. It described its primary stages, secondary stages, and last stages. Fifty to a hundred years after this disease appeared, it became less lethal and virulent. It had several different phases i.e. the first phase was to develop sores in the genitals which were later called chancres (Frith, 2012). After these chancres had healed, one would appear rashes which were accompanied by fevers, muscle and bone aches. After this phase was over, one would live for an extended period without experiencing any severe symptoms. Later the last phase would start to show with symptoms such as weakness, madness or would even lead to death. It was at this stage that people would highly fear syphilis and was viewed as a punishment for people who had sinned sexually. 

The primary treatments of syphilis started in the 16th century when guaiacum, mercury, and holy wood were introduced. Sweat baths were also believed to eliminate syphilis through sweating and induced salivating (Frith, 2012). However, guaiacum was not an effective cure, and people started using mercury as a form of treatment. Mercury had been used for a long time as a kind of treatment for prevalent illnesses since Guy de Chauliac had advocated it in the year 1363. However many physicians doubted the use of mercury due to is serious side effects such as kidney failure. It resulted in the poisoning of the patients which later caused death to very many patients during this time. In the 19th century, several types of metals such as platinum, gold, and vanadium, were tested by many physicians but were not effective. The turning point of treating syphilis was seen in the year 1943 when it penicillin was introduced by Richard Arnold, Ad Harris and John Mahoney (Frith, 2012). Richard and his colleagues treated four patients who were at the primary stage with penicillin and healed. It has fewer side effects compared to other treatment methods used in the previous years. 

CASE STUDY #1 

For the last years, the widespread of syphilis has transpired in many republics in the world including Togo. This has made the deterrence of syphilis become the major priority that the national programs have established to control STDs. Every year, the World Health Organization estimates that nearly 12 million cases of this disease ensue globally of which half of this population is recorded from the sub-Saharan countries in Africa (Halatoko, Landoh, Saka, Akolly, Layibo, Yaya & Pitche, 2011). In this country, studies have shown that syphilis is developed among individuals involved in sexual behavior such as sex workers, homosexuals and people who use drugs. According to a survey conducted in Togo, the number of female sex workers is high than that of male workers. In this study, they define a female sex worker as a woman who would exchange sexual acts with for money in places such as brothels, bar, or streets. 

In the article Prevalence of syphilis among female sex workers and their clients in Togo in 2011 , Hataloko and his colleagues conducted a survey in the year 2009 to identify sex work sites and the number of sex workers in Togo. The results indicate that nearly 8,000 women were sex workers from whom about 490 were official sex workers. About 1,548 were based on the streets and 5,962 performed sex work in secret (Halatoko et al. 2011). The frequency of syphilis amongst female sex workers (FSWs) and their customers was two times greater than that of pregnant women attending clinical check-up. The study showed that syphilis infection was higher in sex workers over the age of 30 years. According to this study, the percentage of both FSWs and their customers was about 2.2% which is almost two times the number of women going for clinics in Togo (Halatoko et al. 2011). This percentage was higher than in Northern Sudan which has about 1.5% and lesser than about 2.7% in Tunisia. Nevertheless, these results from Africa are less related to results from India and China which have 18.4% and 21.1% respectively (Halatoko et al. 2011). 

The high spread of syphilis was as a result of risky sexual behaviors such as having sex with multiple partners and the lack of using condoms. According to the article, only 88% had used a condom during sexual intercourse before the survey was conducted (Halatoko et al. 2011). According to a survey carried out in Uganda, about 94% of female sex workers were reported to have used condoms while in Rwanda nearly 74% used a condom during the previous month in their work. This study also showed that female sex workers aged over 30 years were about 5 times likely to be infected with syphilis (Halatoko et al. 2011). This is because as these sex workers get old, they become reluctant in using preventive measures. This was similar to results reported among African and Chinese female sex workers located in Italy. Unlike the results in Togo, places such as India showed that women at a young age were likely to be infected with STIs including syphilis. The research also revealed that many people living with syphilis were associated with HIV infection. However, it is essential for the national STIs control programs to reinforce the deterrence and management of STIs. 

CASE STUDY #2 

Syphilis among pregnant women has been a non-recognized issue that has become a health and economic burden. According to the article The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model by Kahn James et al., more than half of untreated pregnancies are infected by syphilis which has resulted in severe results such as mother-to-child transmission of syphilis (MTCT). Currently, the burden of syphilis related to MTCT is estimated at 3.6 million screening that exists in many countries globally. However, due to inadequate national programs, nearly more than 60% of expectant women do not obtain any screening or obtain it when it is too late for management (Kahn, Jiwani, Gomez, Hawkes, Chesson, Broutet & Newman, 2014). In the year 2007, WHO started an initiative to address the worldwide MTCT of syphilis through political assurance as well as observing syphilis intervention in existing antenatal care and preventing MTCT of HIV programs. This initiative aimed at ensuring that nearly 90% of expectant women were screened and those identified with syphilis received treatment appropriately (Kahn et al. 2014). 

A study was conducted in various countries to make the cost-effectiveness of syphilis screening and management in ANC programs that existed (Kahn et al. 2014). The results were that the elimination of syphilis through advanced screening and expanded management program in ANC facilities would save costs in four countries out of the eight countries examined. According to WHO, a syphilis intervention is more cost effective if the cost is lower than the per capita GDP (Kahn et al. 2014). WHO, considered that the MTCT elimination program was more cost effective in all cases they explored. According to the article, the analysis made suggested that incorporating expanded syphilis treatment and screening in antenatal programs was highly cost-effective. They concluded that countries which had high cases of maternal syphilis, little service coverage and high costs of healthcare would highlysupport from these programs. 

CASE STUDY #3 

Many methods are used in the treatment of syphilis. These methods include serological tests, direct antigen detection tests and dark field microscopy (Shukla & Mody, 2015). Among all these methods, serology test is the most used method of diagnosing syphilis. Some of the treponemal serological tests available are Fluorescent Treponemal Antibody Absorption Assay (FTA-ABS), T.pallidum Particle Agglutination Assay (TP-PA), T.pallidum Hemagglutionation Assay (TPHA), and Enzyme Immunoassay (EIA) which detects classes of antibodies to treponemal proteins. 

According to the article Syphilis Diagnosis Using an Advance Concept for NonTreponemal Test Development , by Shukla Mayur and Himanshu Mody, treponemal tests are offered in automated forms which become an added advantage compared to non-treponemal test. However, both treponemal and non-treponemal tests are useful in diagnosing syphilis though they both have their limitations. Preparation of antigen of non-treponemal tests uses natural cardiolipin along with cholesterol and lecithin (Shukla & Mody, 2015). To show flocculation, this antigen reacts with non-treponemal antibodies from patients with syphilis. The advantages of this test are that it is economical, easy to monitor and easy to use. Nevertheless, a condition such as viral infections and pregnancy might give a false result, therefore, makes it necessary to confirm with a treponemal test (Shukla & Mody, 2015). Also, all non-treponemal tests are performed manually and not in the automated form which is a limitation over the treponemal tests which are automated (Shukla &Mody, 2015). 

Personal opinion 

From my research, I have learnt that syphilis has become a major concern which has led to many cases of death among the women. In my opinion, the increasing death rate of women as a result of syphilis is associated with the poor medical services in our hospitals and the lack of awareness on protection measures when engaging in sexual activities. I would recommend the government in collaboration with the World Health organization to establish more programs for creating public awareness on syphilis, its symptoms, risk factors, treatment options and most importantly, on prevention measures. Also, the government, through its constituents at the local level, should encourage pregnant women to seek antenatal health care to prevent to avoid the spread of the disease especially to their children. I believe such initiatives will be helpful in reducing the prevalence of syphilis and significantly reducing the death rates associated with it. 

Conclusion 

From this paper, it is clear that from the early time's syphilis was feared greatly by most societies due to the repulsiveness of its symptoms and the pain one endured. It was also feared due to after effects of using mercury as a form of treatment and above all due to the way it was transmitted through human behavior that was inescapable i.e. sexual intercourse. The spread of syphilis among FSWs and their customers have become very high. It is associated with age, marital status, and their worksites. Moreover, those infected with syphilis have high chances of contracting HIV which increase death rates. Therefore, it is essential for national STIs and HIV programs to reinforce the deterrence and management of sexual behavior to reduce the commonness of both HIV and syphilis amongst female sex workers and their customers. 

References 

Frith, J. (2012). Syphilis-its early history and treatment until penicillin, and the debate on its origins. Journal of Military and Veterans Health , 20(4), 49. 

Halatoko, W. A., Landoh, D. E., Saka, B., Akolly, K., Layibo, Y., Yaya, I., &Pitché, P. (2017). Prevalence of syphilis among female sex workers and their clients in Togo in 2011. BMC Public Health , 17(1), 219. 

Hoeger, W. W. K., & Hoeger, S. A. (2008). P rinciples and labs for fitness and wellness. Belmont, CA: Thomson/Wadsworth. 

Kahn, J. G., Jiwani, A., Gomez, G. B., Hawkes, S. J., Chesson, H. W., Broutet, N., ... & Newman, L. M. (2014). The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model. PLoS One , 9(1), e87510. 

Shukla, M. R., & Mody, H. C. (2015). Syphilis Diagnosis Using an Advance Concept for Non- Treponemal Test Development. Current Trends in Biotechnology and Pharmacy , 9(4), 344-347. 

Warrell, D. A., Cox, T. M., Firth, J. D., & Török, E. (2012). Oxford textbook of medicine: Infection. Oxford: Oxford University Press.