Far from the devastating scourge it once was, syphilis is now relatively uncommon in most of the United States. According to the Centers for Disease Control, most cases of the disease — which affected some 35,000 people in 1999, roughly five percent fewer than the previous year — are centered in the southern United States. Of the nine states with the highest rates of syphilis in that year, eight were in the South; there, disease rates are two to five times higher than the national average. Syphilis is one-and-a-half times more common in men than women, and primarily affects people aged 20 to 39. The rate in African Americans is a staggering 30 times higher than the rate in Caucasians; the disease is most likely to affect the poor, and those with inadequate access to health care and quality education.
Venereal syphilis is caused by Treponema pallidum, a corkscrew-shaped bacterium. The bug needs moisture to exist and be spread from person to person, which is why it is passed most often through sexual contact. It can, however, also be passed from an infected mother to her unborn child. Twenty-five percent of the time, infected fetuses will be stillborn or will die soon after birth; infected babies, suffering from a form of the disease called congenital syphilis, can suffer from skin sores, rashes, liver damage, and other health problems.
In adults, untreated syphilis infection characteristically passes through four distinct stages:
The first, or primary stage, occurs immediately after infection with the bacteria. A single small, firm, round sore, or chancre, will develop at the site where the bacterium enters the body. The painless chancre enlarges and often bursts at the center, leaving a small ulcer. The ulcer heals on its own in a few weeks.
The second stage, which can begin weeks or months after the chancre heals, is characterized by a rash of penny-sized brown sores, which can cover various parts of the body and almost always affect the palms and the soles of the feet. Because the sores contain the syphilis bacterium, any contact with them — sexual or otherwise — can pass on the infection. The rash heals in a few weeks to months. Other second-stage symptoms include mild fever, headache, weight loss, fatigue, sore throat, swollen glands, and patchy hair loss.
In some patients, the second stage is followed by a non-contagious, symptom-free latent stage, which can last for a few months, or, in some patients, forever.
About one-fourth of untreated syphilis patients progress to the tertiary stage of the disease, in which the bacterium damages the heart, eyes, brain, nervous system, liver, bones, joints — virtually any part of the body. Tertiary syphilis can cause muscle coordination problems, mental illness, blindness, heart disease — and, ultimately, death. Only patients who have progressed to the tertiary stage will exhibit the tell-tale skeletal changes — such as the thickening of the lower leg bones and cranial damage — that were observed by paleopathologists in the ancient skeletons at the Hull friary (as seen in the SECRETS OF THE DEAD II episode “The Syphilis Enigma”).
Syphilis is generally diagnosed either by microscopic identification of the bacterium or by a blood test, which detects antibodies that the body has produced in response to the infection. In most early cases, a single dose of penicillin will kill off the bacterium; for patients who have been infected longer than about a year, a larger, longer course of antibiotics is necessary. Other antibiotics are effective for patients who are allergic to penicillin. Although syphilis is easily treated (and can usually be prevented altogether by avoiding contact with the infectious sores and with the use of latex condoms), it remains a big public health concern because the genital sores caused by the disease ease the transmission of HIV, the virus that causes AIDS. In fact, the risk of acquiring HIV is 2-5 times higher in patients with syphilis.
