Syphilis is a chronic, degenerative, sexually transmitted disease caused by the bacterium Treponema pallidum. Although modern treatments now control the disease, its incidence remains high worldwide, making it a global public health concern. Spread by sexual contact, syphilis begins as a small, hard, painless swelling, called a primary (or Hunter's) chancre. The disease is very contagious in the early stages. The initial sore will usually pass away in about eight weeks, but the disease will then spread through the body and lodge in the lymph nodes, causing a skin rash to appear in two to four months along with fever and headaches. This second stage can last two to six weeks. After a latent period, which can extend for years, the disease can appear in various bodily organs and it can be spread to others.
The earliest records of syphilis are those of Spanish physician Rodrigo Ruiz de Isla, who wrote that he treated syphilis patients in Barcelona in 1493. He further claimed that the soldiers of explorer Christopher Columbus contracted the disease in the Caribbean and brought it back to Europe in 1492. However, others challenge this position. Some medical historians believe that syphilis has been present from ancient times but was often mislabeled or misdiagnosed. Italian physician and writer Girolamo Fracastoro gave the disease its name in his poem "Syphilis sive morbus Gallicus" (Syphilis or the French Disease), published in 1530, during the height of a European epidemic. However, for centuries, the disease was called pox or the great pox. At that time, the treatment was mercury, used in vapor baths, as an ointment, or taken orally. The mercury increased the flow of saliva and phlegm to wash out the poisons, but it also caused discomfort, such as loss of hair and teeth, abdominal pains, and mouth sores. Through the centuries, a milder form of the disease evolved and often became confused with gonorrhea. In 1767, physician John Hunter infected himself with fluid from a patient who had gonorrhea to prove these were two different diseases. Unknown to Hunter, the patient also had syphilis. Hunter developed the sore indicative of syphilis that now bears his name.
The distinction between the two diseases was made clear in 1879, when German bacteriologist Albert Neisser isolated the bacterium responsible for gonorrhea. In 1903, Russian biologist Elie Metchnikoff and French scientist Pierre-Paul-Emile Roux demonstrated that syphilis could be transmitted to monkeys and then studied in the laboratory. They also showed that mercury ointment was an effective treatment in the early stages. Two years later, German zoologist Fritz Schaudinn and his assistant Erich Hoffmann discovered the bacterium responsible for syphilis, the spiral-shaped spirochete Treponema pallidum. The following year, German physician August von Wassermann (1866-1925) developed the first diagnostic test for syphilis based on new findings in immunology. The test involved checking for the syphilis antibody in a sample of blood. One drawback was that the test would take two days to complete.
In 1904, German research physician Paul Ehrlich began focusing on a safe, effective treatment for syphilis. Ehrlich had spent many years studying the effect of dyes on biological tissues and treatments for tropical diseases. His work in the emerging field of immunology earned him a Nobel Prize in 1908. Ehrlich began working with the arsenic-based compound atoxyl as a possible treatment for syphilis. Japanese bacteriologist Sahachiro Hata came to study syphilis with Ehrlich. Hata tested hundreds of derivatives of atoxyl and finally found one that worked, number 606. Ehrlich called it Salvarsan. Following clinical trials, in 1911 Ehrlich and Hata announced the drug was an effective cure for syphilis. The drug attacked the disease germs but did not harm healthy cells; thus, Salvarsan ushered in the new field of chemotherapy. Ehrlich went on to develop two safer forms of the drug, including neosalvarsan in 1912 and sodium salvarsan in 1913.
Penicillin came into widespread use in treating bacterial diseases during World War II. It was first used to against syphilis in 1943 by New York physician John F. Mahoney, and it remains the treatment of choice today. Other antibiotics are also effective. Meanwhile, Russian-American researcher Reuben Leon Kahn (1887-1979) developed a modified test for syphilis in 1923 that took only a few minutes to complete. Another test was developed by researchers William A. Hinton (1883-1959) and J. A. V. Davies. Today fluorescent antibody tests are used for detection. Although there is no inoculation for syphilis, the disease can be controlled through education, safe sexual practices, and proper medical treatment.
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