Studies shed light on the intriguing history of syphilis

Arecent statistic has caused concern amongst officials at the Ministry of Health– the number of cases of syphilis in New Zealand has doubled in two years to 470.

Syphilis is a serious disease, potentially painful and dangerous. The disease is caused through infection by a bacterium Treponema pallidum and can be effectively, painlessly and quickly treated with penicillin if diagnosed early.

Syphilis is sexually transmitted and has four stages. The primary stage is identified by the presence of a painless ulcer at the site of infection, usually around the genital or mouth areas.

After three to six months, a rash appears that can occur anywhere in the body. This indicates the secondary stage. The next stage with few or no symptoms is called the latent stage and can last for decades.

Following the latent stage is the tertiary stage which is signalled by considerable ulceration of the skin generating uncomfortable heat and can track into bones including the skull, causing extremely painful lesions. Dementia can also occur. Syphilis can be transmitted from mother to baby.

The origin of the disease is unknown, but recent genetic studies are overturning long-held ideas and are revealing an intriguing history.

For hundreds of years it was thought that syphilis was a disease of native American Indians and brought to Europe by the first Europeans to visit the Americas – that is, by Christopher Columbus and his crew in 1492.

In Europe, syphilis was first medically identified and documented after the siege of Naples in 1495. Europe in the 15th century was profoundly religious; acquiring a sexually-transmitted disease was regarded as particularly sinful.

The shame associated with syphilis meant that each nation had a different name for the disease. The Spanish called it the ‘‘French disease’’, the French called it the ‘‘Neapolitan disease’’ and the Germans called it the ‘‘Spanish itch’’.

The long-held belief that syphilis originated in the Americas was severely challenged when, in several locations in Europe, bones from historic burial sites were found to have the tell-tale signs of syphilis.

These include holes in the bones ‘‘caries sicca’’, a hole in the palate (the connection between the mouth and nose) and bone formation at the front of the lower leg called a ‘‘sabre shin’’.

An example of one of these bone exhumations was that of a medieval friary in the English city of Hull – as reported in a UK Channel 5 TV Timeline programme.

The surprising feature of this discovery is that many of the diseased bones have been accurately dated pre-1350 – that is more than 100 years before any European had set foot in the Americas.

These bone discoveries have prompted a revision of the old ideas about the origins of syphilis. Syphilis bacteria need skin-to-skin contact in order to spread.

The latest theory, backed by evidence, is that syphilis in the Americas was not a sexuallytransmitted disease but could be merely transmitted by human contact.

In the tropical climate of the central Americas, the native peoples were lightly clad and the syphilis bacteria were easily transferred between hosts. The bacteria did not need to mutate much to multiply.

The symptoms would have been an ugly skin rash which most people caught in childhood but overcame and which rarely became anything more serious.

In Europe, before any contact with the Americas, syphilis was present but it had mutated substantially. In the cool climate of Europe clothing had to be worn; these conditions were conducive to accelerating the movement of the syphilis bacteria to the moist, warm parts of the body, namely around the genitals. The bacteria mutated into the far more dangerous venereal syphilis, the sexually-transmitted disease we know today.

Tellingly, the medieval cases of syphilis have been found at sites in ports such as Naples and Hull, where there were sailors from many countries and where promiscuity was high, accelerating the distribution and mutation of the bacteria to the venereal strain.

In its early stages it is not obvious to the infected person that they have syphilis and given that many years later it can reappear in a more serious form, the Department of Health advise anyone who is concerned to contact their doctor or clinic.

Roger Hanson