Syphilis Classification and external resources
Image of spiral-shaped organisms responsible for causing syphilis
ICD-10	A50.-A53.
ICD-9	090-097
MedlinePlus	001327
eMedicine	med/2224  emerg/563 derm/413

Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors A sexually transmitted disease ( STD) or venereal disease ( VD) is an illness that has a significant probability of transmission between Humans Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T Spirochaetes is a phylum of distinctive Gram-negative bacteria, which have long helically coiled cells The route of transmission of syphilis is almost always by sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero. Generally speaking human sexuality is how people experience and express themselves as sexual beings Congenital syphilis is Syphilis present in utero and at birth and occurs when a child is born to a mother with secondary or tertiary syphilis For the Nirvana album see In Utero. In utero is a Latin term literally meaning "in the Uterus " The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum Diagnosis is the identification by Process of elimination, of the nature of anything In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Syphilis (unless antibiotic-resistant) can be easily treated with antibiotics including penicillin. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections The oldest and still most effective method is an intramuscular injection of benzathine penicillin. Intramuscular injection is the injection of a substance directly into a Muscle. Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections If not treated, syphilis can cause serious effects such as damage to the heart, aorta, brain, eyes, and bones. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce In some cases these effects can be fatal. In 1998, the complete genetic sequence of T. A DNA sequence or genetic sequence is a succession of letters representing the Primary structure of a real or hypothetical DNA Molecule pallidum was published which may aid understanding of the pathogenesis of syphilis. The term pathogenesis means step by step development of a disease due to a series of changes in the structure and /or function of a cell/tissue/organ being caused by a microbial, chemical or physical

Alternative names

The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his epic noted poem, written in Latin, entitled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. Girolamo Fracastoro ( Fracastorius) (1478‑ August 8, 1553) was an Italian Physician, Scholar (in Mathematics An epic is a lengthy Narrative poem, ordinarily concerning a serious subject containing details of heroic deeds and events significant to a culture or nation Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). A shepherd is a person who tends to feeds or guards Sheep, especially in flocks Publius Ovidius Naso ( March 20, 43 BC – 17 AD was a Roman poet known to the English -speaking world as Ovid who wrote on many topics including The Metamorphoses by the Roman poet Ovid is a narrative poem Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases"). ^[1]

Until that time, as Fracastoro notes, syphilis had been called the "French disease" in Italy and Germany, and the "Italian disease" in France. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", the Turks called it the "Christian disease" or "Frank disease" (frengi) and the Tahitians called it the "British disease". These 'national' names are due to the disease often being present among invading armies or sea crews, due to the high instance of unprotected sexual contact with prostitutes. Prostitution is the act of performing Sexual activity in exchange for Money. It was also called "Great pox" in the 16th century to distinguish it from smallpox. Smallpox is an Infectious disease unique to humans caused by either of two virus variants named Variola major and Variola minor. In its early stages, the Great pox produced a rash similar to smallpox (also known as variola). Smallpox is an Infectious disease unique to humans caused by either of two virus variants named Variola major and Variola minor. However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues" (or Lues venerea, Latin for "venereal plague") and "Cupid's disease" have also been used to refer to syphilis. Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. In Roman mythology, Cupid (Latin cupido) is the god of Erotic Love and Beauty. In Scotland, Syphilis was referred to as the Grandgore. Scotland ( Gaelic: Alba) is a Country in northwest Europethat occupies the northern third of the island of Great Britain. The ulcers suffered by British soldiers in Portugal was termed "The Black Lion". ^[2]

Origins

There have been three theories on the origin of syphilis which formed an ongoing debate in anthropological and historical fields. Anthropology (/ˌænθɹəˈpɒlədʒi/ from Greek grc ἄνθρωπος anthrōpos, "human" -λογία -logia) is the study of History is the study of the past particularly the written record Those who study history as a Profession are called Historians Etymology

The pre-Columbian theory holds that syphilis symptoms are described by Hippocrates in Classical Greece in its venereal/tertiary form. The pre-Columbian era incorporates all period subdivisions in the history and prehistory of the Americas before the appearance of significant European influences Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca In the context of the art architecture and culture of Ancient Greece, the classical period corresponds to most of the 5th and 4th centuries A sexually transmitted disease ( STD) or venereal disease ( VD) is an illness that has a significant probability of transmission between Humans There are other suspected syphilis findings for pre-contact Europe, including at a 13–14th century Augustinian friary in the northeastern English port of Kingston upon Hull. The Augustinians, named after Saint Augustine of Hippo (died AD 430) are several Catholic Monastic orders and congregations This article concerns the buildings occupied by monastics. For the life inside monasteries and its historical roots see Monasticism. Kingston upon Hull ( almost invariably referred This city's maritime history is thought to have been a key factor in the transmission of syphilis. ^[3] Carbon dated skeletons of monks who lived in the friary showed bone lesions typical of venereal syphilis. Radiocarbon dating is a Radiometric dating method that uses the naturally occurring Radioisotope Carbon-14 (14C to determine the age of Skeletons in pre-Columbus Pompeii and Metaponto in Italy demonstrating signs of congenital syphilis have also been found^[4][5], although the interpretation of the evidence has been disputed. Pompeii is a ruined and partially buried Roman town-city near modern Naples and Caserta in the Italian region of Campania, in Metaponto is a small town of about a 1000 people in the Province of Matera, Basilicata, Italy. ^[6]

The Columbian Exchange theory holds that syphilis was a New World disease brought back by Columbus and Martin Alonzo Pinzon. The Columbian Exchange has been one of the most significant events in the history of world Ecology, Agriculture, and Culture. The New World is one of the names used for the non-Eurasian/non-African parts of the Earth specifically the Americas and Australia. Christopher Columbus (1451 &ndash May 20 1506 was an Italian Navigator, colonizer Martín Alonso Pinzón, ( Palos de la Frontera, Huelva; c 1441 &ndash March 1493 Spanish navigator and explorer. Supporters of the Columbian theory find syphilis lesions on pre-contact Native Americans and cite documentary evidence linking crewmen of Columbus's voyages to the Naples outbreak of 1494. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma For indigenous peoples in the United States other than Hawaii and Alaska see also Native Americans in the United States. ^[7] A recent study of the genes of venereal syphilis and related bacteria has supported this theory, by locating an intermediate disease between yaws and syphilis in Guyana, South America. Yaws (also Pétasse tropica, thymosis, polypapilloma tropicum, pian or parangi) is a tropical Infection ^[8][9]

Historian Alfred Crosby suggests both theories are correct in a combination theory. Crosby's argument is built on the similarities of the species of bacteria which cause yaws and syphilis. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have The bacterium that causes syphilis belongs to the same phylogenetic family as the bacteria which cause yaws and several other diseases. Yaws (also Pétasse tropica, thymosis, polypapilloma tropicum, pian or parangi) is a tropical Infection Despite a tradition of assigning yaws's homeland to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease being present in pre-Columbian Europe, Africa, or Asia, while there is indisputable evidence of syphilis' presence in the pre-Columbian Americas. Sub-Saharan Africa is a geographical term used to describe the area of the African continent which lies south of the Sahara, or those African countries Conceding this point, Crosby writes, "It is not impossible that the organisms causing treponematosis arrived from America in the 1490s. Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T . . and evolved into both venereal and non-venereal syphilis and yaws. "^[10]

However, Crosby considers it somewhat more likely that a highly contagious ancestral species of bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. The Bering Strait (Берингов пролив Beringov proliv) is a sea Strait between Cape Dezhnev, Russia, the easternmost point (169°43' He hypothesizes that "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases. Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T "^[10] Thus, a weak, non-syphilitic bacteria survived in the Old World to eventually give rise to yaws or bejel, while a New World version evolved into the milder pinta and the more aggressive syphilis. Bejel, or endemic syphilis, is a chronic skin and tissue disease caused by infection by a subspecies of the Spirochete Treponema pallidum. Pinta is a human Skin disease endemic to Mexico, Central America, and South America.

Going further than Crosby in arguing for worldwide incidence of syphilis prior to Columbus, Douglas Owsley, the famed physical anthropologist at the Smithsonian Institution, has written that many medieval European cases of leprosy, colloquially called "lepra," were actually cases of syphilis. Biological anthropology, or physical anthropology is a branch of Anthropology that studies the mechanisms of biological Evolution, genetic inheritance The Smithsonian Institution (smɪθsoʊnɪən is an educational and research institute and associated Museum complex administered and funded by the Government of Although folklore claimed that syphilis was unknown in Europe until the return of the diseased sailors of the Columbian voyages,

Owsley noted that a Chinese medical case recorded in 2637 B. C. E. seems to be describing a case of syphilis, and that a European writer who recorded an outbreak of "lepra" in 1303 C. E. is "clearly describing syphilis". ^[11]

History

Portrait of Gerard de Lairesse by Rembrandt van Rijn, ca. Gerard de Lairesse ( Liège, 1640 or 1641 &ndash Amsterdam, 1711) also Gérard de Lairesse, was a Dutch Golden Age Rembrandt Harmenszoon van Rijn (July 15 1606 &ndash October 4 1669 was a Dutch painter and etcher. 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, suffered from congenital syphilis that severely deformed his face and eventually blinded him. ^[12]

While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, proving that Treponema pallidum was the cause of the disease. The Rockefeller University is a private University which focuses primarily on basic research in the biomedical fields and offers graduate and postgraduate education also known as, was a prominent Japanese Bacteriologist who discovered the agent of Syphilis in 1911 For a topic outline on this subject see List of basic Japan topics. Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T ^[13] Prior to Noguchi's discovery, syphilis had been a burden to humanity in many lands, sometimes misdiagnosed and often misattributed to political enemies.

Some famous historical personages, including Franz Schubert, Benjamin Keith Hamer, Hernando Cortez of Spain, Adolf Hitler, Benito Mussolini, and Ivan the Terrible, have been alleged to have had syphilis. Charles VIII, called the Affable (l'Affable 30 June 1470 &ndash 7 April 1498 was King of France from 1483 to his death Hernán Cortés de Monroy y Pizarro 1st Marqués del Valle de Oaxaca ( 1485&ndash December 2, Hi and welcome to Wikipedia! Please understand that this article is frequently vandalized and vandalism is reverted immediately Guy de Maupassant and possibly Friedrich Nietzsche are thought to have been driven insane and ultimately killed by the disease. Guy de Maupassant (gi də mopasɑ̃ (5 August 1850 &ndash 6 July 1893 was a popular 19th-century French Writer and considered one of the fathers of the modern Friedrich Wilhelm Nietzsche (October 15 1844 August 25 1900 ( was a nineteenth-century German philosopher and classical philologist Traditionally insanity or madness is the behaviour whereby a person flouts societal norms and may become a danger to himself and others Al Capone contracted syphilis as a young man. Alphonse Gabriel "Al" Capone (January 17 1899 &ndash January 25 1947 commonly nicknamed Scarface, was an Italian American Gangster who By the time he was incarcerated at Alcatraz, it reached its third stage, neurosyphilis, leaving him confused and disoriented. Alcatraz Island, sometimes informally referred to as simply Alcatraz or locally as the Rock, is a small island located in the middle of San Francisco Bay Syphilis led to the death of artist Edouard Manet and artist Paul Gauguin is also said to have suffered from syphilis. Eugène Henri Paul Gauguin (7 June 1848 – 8 May 1903 was a leading Post-Impressionist painter. Composers who succumbed to syphilis include Hugo Wolf, Frederick Delius, Scott Joplin and possibly Franz Schubert and Niccolò Paganini. Hugo Wolf (March 13 1860 – February 22 1903 was an Austrian Composer of Slovene origin particularly noted for his art songs or Lieder. Frederick Albert Theodore Delius CH (29 January 1862 &ndash 10 June 1934 was an English Composer born in Bradford in the West Riding of Yorkshire Scott Joplin (between June 1867 and January 1868 &ndash April 1 1917 was an American musician and Composer of Ragtime music Niccolò Paganini ( October 27, 1782 &ndash

The insanity caused by late-stage syphilis was once one of the more common forms of dementia; this was known as the general paresis of the insane. Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline General paresis, also known as general paralysis of the insane or paralytic dementia, is a now-rare neuropsychiatric disorder affecting the brain One suspected example is the insanity of noted composer Robert Schumann, although the precise cause of his death is still disputed by scholars. Robert Schumann, sometimes given as Robert Alexander Schumann (June 8 1810 &ndash July 29 1856 was a German Composer, Aesthete and influential Music critic

The Russian author Leo Tolstoy suffered from syphilis during his youth, which was cured using arsenic treatment. Leo Tolstoy, or Count Lev Nikolayevich Tolstoy ( –) (Лев Никола́евич Толсто́й, was a Russian Writer widely regarded ^[14]

A recent article in the European Journal of Neurology (June 2004) hypothesized that the founder of communism in Russia, Vladimir Ilyich Lenin, died of neurosyphilis. ^[15]

The rock critic Lester Bangs caught syphilis and was cured of it in his youth. Leslie Conway Bangs ( December 13, 1948 &ndash April 30, 1982) was an American music journalist, author and musician

Karen Blixen, the author of Out of Africa, contracted syphilis from her husband while living in Africa. Baroness Karen von Blixen-Finecke ( April 17, 1885 &ndash September 7, 1962) Née Karen Dinesen, was a He had contracted the disease from an African woman with whom he had been unfaithful. After having undergone treatment in Denmark, she returned to Africa. Blixen was unable to have children.

European outbreak

A medical illustration attributed to Albrecht Dürer (1496) depicting a person with syphilis. Albrecht Dürer (ˈalbʀɛçt ˈdyʀɐ ( May 21, 1471 &ndash April 6, 1528) was a German painter, Printmaker Here, the disease is believed to have astrological causes. Astrology (from Greek grc ἄστρον astron, "constellation star" and grc -λογία -logia) is a group of Systems

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples. Naples ( Napoli, Neapolitan: Nàpule) is a historic City in southern Italy, the Capital of the ^[16] The French may have caught it via Spanish mercenaries serving King Charles of France in that siege. ^[11] From this centre, the disease swept across Europe. As Jared Diamond describes it, "when syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months. TemplateInfobox writer --> Jared Mason Diamond (b 10 September, 1937) is an American Evolutionary biologist A pustule is a small collection of Pus in the top layer of Skin ( epidermis) or beneath it in the Dermis. " In addition, the disease was more frequently fatal than it is today. Diamond concludes that "by 1546, the disease had evolved into the disease with the symptoms so well known to us today. "^[17] The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the

Notable known and suspected syphilis-infected people in previous centuries

Keys: S - suspected case; † - died of syphilis

Syphilis infection

Different manifestations occur depending on the stage of the disease:

Primary syphilis

Primary chancre of syphilis at the site of infection on the hand

Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of a person with syphilis. A chancre is a painless ulceration formed during the primary stage of Syphilis. ^[18] Approximately 10-90 days after the initial exposure (average 21 days), a skin lesion appears at the point of contact, which is usually the genitalia, but can be anywhere on the body. A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina or rectum. A chancre is a painless ulceration formed during the primary stage of Syphilis. The penis (plural penises, penes The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals Rarely, there may be multiple lesions present although typically only one lesion is seen. The lesion may persist for 4 to 6 weeks and usually heals spontaneously. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma Local lymph node swelling can occur. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. During the initial incubation period, individuals are otherwise asymptomatic. As a result, many patients do not seek medical care immediately.

Syphilis can not be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing. ^[19]

Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet

Secondary syphilis

Secondary syphilis occurs approximately 1-6 months (commonly 6 to 8 weeks) after the primary infection. There are many different manifestations of secondary disease. There may be a symmetrical reddish-pink non-itchy rash on the trunk and extremities. ^[20] The rash can involve the palms of the hands and the soles of the feet. In moist areas of the body, the rash becomes flat broad whitish lesions known as condylomata lata. Mucous patches may also appear on the genitals or in the mouth. All of these lesions are infectious and harbor active treponeme organisms. A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris See also Strep throat. Pharyngitis (ˌfarɪnˈdʒʌɪtɪs is in most cases a Painful inflammation of the Pharynx, and is Malaise is a feeling of general discomfort or uneasiness an "out of sorts" feeling often the first indication of an infection or other disease Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Meningism is the triad of nuchal rigidity Photophobia (intolerance of bright light and Headache. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, intersitial keratitis, iritis, and uveitis. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of The kidneys are complicated organs that have numerous biological roles Gastritis is an inflammation of the lining of the stomach There are many possible causes Proctitis is an Inflammation of the Anus and the lining of the Rectum, affecting only the last 6 inches of the rectum Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Shin splints is a general term used to refer to a painful condition in the shins. Optic Neuritis is the Inflammation of the Optic nerve that may cause a complete or partial loss of vision Iritis is a form of anterior Uveitis and refers to the Inflammation of the iris of the Eye. Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory

Latent syphilis

Latent syphilis is defined as having serologic proof of infection without signs or symptoms of disease. ^[18] Latent syphilis is further described as either early or late. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk for transmission. In the real-world, the timing of infection is often not known and should be presumed to be late for the purpose of therapy. Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. For infectiousness, however, late latent syphilis is not considered as contagious as early latent syphilis.

Tertiary syphilis

Tertiary syphilis usually occurs 1-10 years after the initial infection, though in some cases it can take up to 50 years. This stage is characterized by the formation of gummas which are soft, tumor-like balls of inflammation known as granulomas. A gumma is a soft non-cancerous growth resulting from the tertiary stage of Syphilis. In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted The granulomas are chronic and represent an inability of the immune system to completely clear the organism. Gummas were once readily seen in the skin and mucous membranes although they tend to occur internally in recent history. They may appear almost anywhere in the body including in the skeleton. The gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Other characteristics of untreated tertiary syphilis include neuropathic joint disease, which is a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). Neuropathic osteoarthropathy refers to progressive degeneration of a Weight bearing Joint, a process marked by bony destruction Bone resorption, and Proprioception (ˌproʊpriːəˈsɛpʃən PRO -pree-o-SEP-shun from Latin proprius, meaning "one's own" and perception is the Sense The more severe manifestations include neurosyphilis and cardiovascular syphilis. Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. In a study of untreated syphilis, 10% of patients developed cardiovascular syphilis, 16% had gumma formation, and 7% had neurosyphilis. ^[21]

Neurological complications at this stage can be diverse. The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself In some patients, manifestations include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupil. General paresis, also known as general paralysis of the insane or paralytic dementia, is a now-rare neuropsychiatric disorder affecting the brain Argyll Robertson pupils (“AR pupils” are bilateral small Pupils that constrict when the patient focuses on a near object (they “ accommodate ” but do This is a diagnostic sign in which the small and irregular pupils constrict in response to focusing the eyes, but not to light. Tabes dorsalis, also known as locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait. Tabes dorsalis is a slow degeneration of the Nerve cells and nerve fibers that carry sensory information to the Brain. Locomotor Ataxia is inability to control one's body movements as intended The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected See below for more information about neurosyphilis.

Cardiovascular complications include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. This is an article about the rock music band "Circulatory System" A pathological state of the aorta associated with the tertiary stage of Syphilis infection ' Aneurysm of the Aortic sinus ', also known as the Sinus of Valsalva, is comparatively rare occurring in about one person in every thousand Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. Murmurs are abnormal Heart sounds that are produced as a result of turbulent blood flow which is sufficient to produce audible noise The course can be insidious, and heart failure may be the presenting sign after years of disease. Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply The infection can also occur in the coronary arteries and cause narrowing of the vessels. Coronary circulation is the circulation of blood in the Blood vessels that supply Blood to and from the Heart muscle Syphilitic aortitis can cause de Musset's sign,^[22] a bobbing of the head that de Musset first noted in Parisian prostitutes.

Neurosyphilis

Neurosyphilis refers to a site of infection involving the central nervous system (CNS). In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Neurosyphilis may occur at any stage of syphilis. Before the advent of antibiotics, it was typically seen in 25-35% of patients with syphilis. Neurosyphilis is now most common in patients with HIV infection. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Reports of neurosyphilis in HIV-infected persons are similar to cases reported before the HIV pandemic. A pandemic (from Greek παν pan all + δήμος demos people is an Epidemic of Infectious disease that spreads through The precise extent and significance of neurologic involvement in HIV-infected patients with syphilis, reflected by either laboratory or clinical criteria, have not been well characterized. Furthermore, the alteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization. Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system.

Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement, as demonstrated by any of these on cerebrospinal fluid (CSF) examination:

• An abnormal leukocyte cell count, protein level, or glucose level
• Demonstrated reactivity to Venereal Disease Research Laboratory (VDRL) antibody test

There are four clinical types of neurosyphilis:

• Asymptomatic neurosyphilis
• Meningovascular syphilis
• General paresis^[23]
• Tabes dorsalis

The late forms of neurosyphilis (tabes dorsalis and general paresis) are seen much less frequently since the advent of antibiotics. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system The Venereal Disease Research Laboratory test or VDRL was developed by the former Venereal Disease Research Laboratory now the Treponemal Pathogenesis and Immunology Branch of the United General paresis, also known as general paralysis of the insane or paralytic dementia, is a now-rare neuropsychiatric disorder affecting the brain Tabes dorsalis is a slow degeneration of the Nerve cells and nerve fibers that carry sensory information to the Brain. The most common manifestations today are asymptomatic or symptomatic meningitis. Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. Patients present with headache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve. Cranial nerves are Nerves that emerge directly from the Brain stem in contrast to Spinal nerves which emerge from segments of the Spinal cord. The optic nerve, also called cranial nerve II, is the Nerve that transmits visual information from the Retina to the Brain. The facial nerve is the seventh (VII of twelve paired Cranial nerves. The vestibulocochlear nerve (also known as the auditory or acoustic nerve) is the eighth of twelve Cranial nerves, and is responsible for transmitting sound Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.

Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary syphilis infection. Meningovascular syphilis can be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable. In Medicine, a prodrome is an early non-specific Symptom (or set of symptoms indicating the start of a Disease before specific symptoms occur Prodromal symptoms include unilateral numbness, paresthesias, upper or lower extremity weakness, headache, vertigo, insomnia, and psychiatric abnormalities such as personality changes. Paresthesia (pron /ˌpɛɹɪsˈθiʒə/ paraesthesia in British English, pron A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Vertigo (from the Latin vertere, to turn and the suffix -igo, a condition i Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity The focal deficits initially are intermittent or progress slowly over a few days. However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients. Arteritis (not to be confused with Arthritis) is Inflammation of the walls of arteries, usually as a result of Infection or Auto-immune In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion. Angiography or arteriography is a Medical imaging technique in which an X-ray image is taken to visualize the inside or lumen, of blood vessels

General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis. It is a chronic dementia which ultimately results in death in as little as 2-3 years. Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Patients generally have progressive personality changes, memory loss, and poor judgment. More rarely, they can have psychosis, depression, or mania. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Imaging of the brain usually shows atrophy.

Diagnostic tests

Early 20th century

In 1906, the first effective test for syphilis, the Wassermann test, was developed. Year 1906 ( MCMVI) was a Common year starting on Monday (link will display full calendar of the Gregorian calendar (or a Common year starting The Wassermann test is a Complement-fixation ( Complement system) Antibody test for Syphilis, named after the bacteriologist August von Wassermann Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wassermann test. The 1930s were described as an abrupt shift to more radical and conservative lifestyles as countries were struggling to find a solution to the Great Depression. William Augustus Hinton (b 15 December 1883 Chicago Illinois d Flocculation is a process where a Solute comes out of Solution in the form of floc or flakes In Statistics, the terms Type I error (also α error, or false positive) and type II error ( β error, or a false negative Both of these early tests have been superseded by newer analytical methods.

Modern diagnostic tests

It was only in the 20th century that effective tests and treatments for syphilis were developed. The twentieth century of the Common Era began on Microscopy of fluid from the primary or secondary lesion using darkfield illumination can diagnose treponemal disease with high accuracy. Microscopy is the technical field of using microscopes to view samples or objects As there are other treponemes that may be confused with T. pallidum, care must be taken in evaluating with microscopy to correlate symptoms with the correct disease.

Star Wars themed parade float promoting syphilis testing at a 2005 parade in Seattle, Washington, United States.

Present-day syphilis screening tests, such as the Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests are cheap and fast but not completely specific, as many other conditions can cause a positive result. Rapid Plasma Reagin (RPR refers to a type of test that looks for non-specific antibodies in the blood of the patient that may indicate that the organism ( Treponema The Venereal Disease Research Laboratory test or VDRL was developed by the former Venereal Disease Research Laboratory now the Treponemal Pathogenesis and Immunology Branch of the United These tests are routinely used to screen blood donors. Notably, the spirochete that causes syphilis does not survive the conditions used to store blood and the number of transfusion transmitted cases of syphilis is minuscule, but the test is used to identify donors that might have contracted HIV from high risk sexual activity. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome The requirement to test for syphilis has been challenged due to the vast improvements in HIV testing. HIV tests are used to detect the presence of the Human immunodeficiency virus in serum, Saliva, or Urine. False positives on the rapid tests can be seen in viral infections (Epstein-Barr, hepatitis, varicella, measles), lymphoma, tuberculosis, malaria, Chagas Disease, endocarditis, connective tissue disease, pregnancy, intravenous drug abuse, or contamination. The Epstein-Barr Virus ( EBV) also called Human herpesvirus 4 (HHV-4 is a Virus of the herpes family (which includes Herpes Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of Chickenpox is a highly contagious illness caused by primary infection with Varicella zoster virus (VZV Measles (rubeola is a Disease caused by a virus specifically a Paramyxovirus of the genus Morbillivirus. Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including Chagas disease (doença de Chagas enfermedad de Chagas mal de Chagas in both languages also called American trypanosomiasis) is a tropical Parasitic Endocarditis is an Inflammation of the inner layer of the Heart, the Endocardium. A connective tissue disease is any disease that has the connective tissues of the body as a target of pathology Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female ^[18] As a result, these two screening tests should always be followed up by a more specific treponemal test. Tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum hemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific and more expensive. Monoclonal antibodies ( mAb or moAb) are monospecific antibodies that are identical because they are produced by one type of immune cell Immunofluorescence is the labeling of antibodies or Antigens with fluorescent Dyes This technique is often used to visualize the subcellular The Syphilis TPHA test is a classic indirect hemagglutination test used for the detection and titration of antibodies against the causative agent of Syphilis, Treponema FTA-ABS is a treponemal test for Syphilis. Using antibodies specific for the Treponema pallidum species such tests are more specific than Non-Treponemal testing such Unfortunately, false positives can still occur in related treponomal infections such as yaws and pinta. Yaws (also Pétasse tropica, thymosis, polypapilloma tropicum, pian or parangi) is a tropical Infection Pinta is a human Skin disease endemic to Mexico, Central America, and South America. Tests based on enzyme-linked immunoassays are also used to confirm the results of simpler screening tests for syphilis. Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins An immunoassay is a Biochemical test that measures the Concentration of a substance in a biological liquid typically serum or Urine, using the

Neurosyphilis is diagnosed by finding high numbers of leukocytes in the CSF or abnormally high protein concentration in the setting of syphilis infection. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system ^[18] In addition, CSF should be tested with the VDRL test although some advocate using the FTA-ABS test to improve sensitivity. There is anecdotal evidence that the incidence of neurosyphilis is higher in HIV patients, and some have recommended that all HIV-positive patients with syphilis should have a lumbar puncture to look for asymptomatic neurosyphilis. In Medicine, a lumbar puncture (colloquially known as a spinal tap) is a Diagnostic and at times therapeutic procedure that is performed in order ^[24]

Diseases caused by other species of Treponema

These diseases are caused by other species or subspecies of Treponema:

• Yaws is a tropical disease characterized by an infection of the skin, bones and joints; it is caused by a spirochete bacterium, Treponema pallidum, sp. Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T Yaws (also Pétasse tropica, thymosis, polypapilloma tropicum, pian or parangi) is a tropical Infection pertenue, also called Treponema pertenue
• Pinta - caused by Treponema carateum
• Bejel - caused by Treponema endemicum

Treatment

Depression-era U. Pinta is a human Skin disease endemic to Mexico, Central America, and South America. Bejel, or endemic syphilis, is a chronic skin and tissue disease caused by infection by a subspecies of the Spirochete Treponema pallidum. S. poster advocating early syphilis treatment

Application of mercury.

Prevention

While abstinence from any sexual activity is very effective at helping prevent syphilis, it should be noted that T. pallidum readily crosses intact mucosa and cut skin, including areas not covered by a condom. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in Proper and consistent use of a latex condom is effective against the spread of syphilis through sexual contact. LaTeX (ˈleɪtɛ A condom is a device most commonly used during Sexual intercourse. [1]

Individuals sexually exposed to a person with primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be assumed to be infected and treated for syphilis, even if they are currently seronegative. If the exposure was more than 90 days before the diagnosis, presumptive treatment is recommended if serologic testing is not immediately available or if follow-up is uncertain. Patients with syphilis of unknown duration and nontreponemal serologic titers ≥1:32 may be considered as having early syphilis for purposes of partner notification and presumptive treatment of sex partners. Long-term sex partners of patients with late syphilis should be evaluated clinically and serologically and treated appropriately. All patients with syphilis should be tested for HIV. Patient education is important as well.

History

There were originally no effective treatments for syphilis. The Spanish priest Francisco Delicado wrote El modo de adoperare el legno de India (Rome, 1525) about the use of Guaiacum in the treatment of syphilis. Francisco Delicado (or Delgado) (c 1480 &ndash c 1535 was a Spanish Writer and editor of the Renaissance. He himself suffered from syphilis. Another common remedy was mercury: the use of which gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury". Mercury (ˈmɜrkjʊri also called quicksilver or hydrargyrum, is a Chemical element with the symbol Hg ( Latinized hydrargyrum Venus was a major Roman Goddess principally associated with Love, Beauty and fertility, the equivalent of the Greek goddess "Alipes" redirects here For the Centipede Genus, see Alipes (centipede. ^[25] It was administered multiple ways including by mouth and by rubbing it on the skin. One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box which caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body.

As the disease became better understood, more effective treatments were found. The first antibiotic to be used for treating disease was the arsenic-containing drug Salvarsan, developed in 1908 by Sahachiro Hata while working in the laboratory of Nobel prize winner Paul Ehrlich. Arsenic (ˈɑrsənɪk is a Chemical element that has the symbol As and Atomic number of 33 Arsphenamine, also known as Salvarsan and 606, is a drug that was used to treat Syphilis and trypanosomiasis. Year 1908 ( MCMVIII) was a Leap year starting on Wednesday (link will display the full calendar of the Gregorian calendar (or a Leap year ( 23 March 1873 – 22 November 1938) was a Japanese Bacteriologist who developed the Arsphenamine drug in The Nobel Prize (Nobelpriset (Nobelprisen is a Swedish prize established in the 1895 will of Swedish chemist Alfred Nobel; it was first awarded in Peace, Literature Paul Ehrlich ( March 14, 1854 &ndash August 20, 1915) was a German Scientist who won the 1908 Nobel This was later modified into Neosalvarsan. Neosalvarsan is a synthetic Chemotherapeutic that is an Organoarsenic compound. Unfortunately, these drugs were not 100% effective, especially in late disease. It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers. Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including This was considered an acceptable risk because the malaria could later be treated with quinine which was available at that time. Quinine (ˈkwaɪnaɪn kwɪˈniːn ˈkwiːniːn is a natural white Crystalline Alkaloid having Antipyretic (fever-reducing antimalarial, This discovery was championed by Julius Wagner-Jauregg, who won the 1927 Nobel Prize for Medicine for his work in this area. Julius Wagner-Jauregg, ( March 7, 1857 Wels, Upper Austria – September 27, 1940 Vienna) was an Austrian physician Year 1927 ( MCMXXVII) was a Common year starting on Saturday (link will display full calendar of the Gregorian calendar. The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured. Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Manufacturing (from Latin manu factura, "making by hand" is the use of tools and labor to make things for use or sale World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including ^[26]

Current treatment

The first-choice treatment for all manifestations of syphilis remains penicillin in the form of penicillin G. Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections ^[27] The effect of penicillin on syphilis was widely known before randomized clinical trials were used; as a result, treatment with penicillin is largely based on case series, expert opinion, and years of clinical experience. Parenteral penicillin G is the only therapy with documented effect during pregnancy. In Pharmacology and Toxicology, a route For early syphilis, one dose of penicillin is sufficient.

Non-pregnant individuals who have severe allergic reactions to penicillin (e. g. , anaphylaxis) may be effectively treated with oral tetracycline or doxycycline although data to support this is limited. Anaphylaxis is an acute systemic (multi-system and severe Type I Hypersensitivity allergic reaction in humans and other Mammals This article deals with the specific antibiotic called tetracycline Doxycycline ( INN) (ˌdɒksɪˈsaɪkliːn is a member of the Tetracycline antibiotics group and is commonly used to treat a variety of Infections Doxycycline Ceftriaxone may be considered as an alternative therapy, although the optimal dose is not yet defined. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. However, cross-reactions in penicillin-allergic patients with cephalosporins such as ceftriaxone are possible. The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Azithromycin was suggested as an alternative. Azithromycin is an Azalide, a subclass of Macrolide Antibiotics. However, there have been reports of treatment failure due to resistance in some areas. ^[28] If compliance and follow-up cannot be ensured, the CDC recommends desensitization with penicillin followed by penicillin treatment. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated For medical purposes desensitization is a method to reduce or eliminate an organism's negative reaction to a substance or stimulus All pregnant women with syphilis should be desensitized and treated with penicillin. Follow-up includes clinical evaluation at 1 to 2 weeks followed by clinical and serologic evaluation at 3, 6, 9, 12, and 24 months after treatment.

Azithromycin has been used to treat syphilis in the past because of easy once-only dosing. However, in one study in San Francisco, azithromycin-resistance rates in syphilis, which were 0% in 2000, were 56% by 2004. ^[29]

Late latent and infections of unknown duration

Late latent syphilis is defined as latency for greater than one year. If CSF examination yields no evidence of neurosyphilis, then penicillin G is recommended as weekly doses for 3 weeks. If allergic, then tetracycline or doxycycline may also be used for this stage, but for 28 days instead of the normal 14. As with before, the data to support use of tetracycline and ceftriaxone are limited.

Neurosyphilis

For patients diagnosed with neurosyphilis including ocular or auditory syphilis with or without positive CSF results, aqueous crystalline penicillin G is the treatment of choice. The recommended regimen is intravenous treatment every 4 hours or continuously for 10-14 days. If intravenous administration is not possible, then procaine penicillin is an alternative (administered daily with probenecid for two weeks). Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Probenecid is a Uricosuric drug primarily used in treating Gout or Hyperuricemia, that increases uric acid removal in the urine Procaine injections are painful, however, and patient compliance may be difficult to ensure. To approximate the 21-day course of therapy for late latent disease and to address concerns about slowly dividing treponemes, most experts now recommend 3 weekly doses of benzathine penicillin G after the completion of a 14-day course of aqueous crystalline or aqueous procaine penicillin G for neurosyphilis. No oral antibiotic alternatives are recommended for the treatment of neurosyphilis. The only alternative that has been studied and shown to be effective is intramuscular ceftriaxone daily for 14 days. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Neurosyphilis dementia is also a psychiatric diagnosis where as a multitude of atypical anti-psychotic medications are used to help control the patient's irrational behaviors with limited success. Also used in traditional classification of Organic Disorders in the brain. Also commonly called Brain Syphilis.

Alternative regimens

Alternative regimens such as tetracyclines are not well studied in HIV infection and a careful follow-up is recommended. Tetra-cyclines are contraindicated in pregnancy.

HIV-infected patients with early syphilis may have a higher risk of neurological complications and a higher rate of treatment failure with currently recommended regimens. The magnitude of these risks, however, although not precisely defined, is probably small. Skin testing or desensitization is recommended in latent syphilis and neurosyphilis in other patients with HIV infection.

Jarisch-Herxheimer reaction

Before administering any treatment, clinicians should warn all patients about the possibility of a Jarisch-Herxheimer reaction, which occurs most often in secondary syphilis and with penicillin therapy, and may be more common in HIV-infected patients. The Herxheimer reaction (also known as Jarisch-Herxheimer or herx) occurs when large quantities of toxins are released into the body as bacteria (typically Spirochetal ^[30] This reaction is characterized by fever, fatigue, and transient worsening of any mucocutaneous symptoms, and usually subsides within 24 hours. These symptoms can be alleviated with acetaminophen (paracetamol) and should not be mistaken for drug allergy. Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication In addition, clinicians should inform HIV-infected patients that currently recommended regimens may be less effective for them than for patients without HIV infection and that close serologic follow-up is therefore essential.

Tuskegee syphilis study

Main article: Tuskegee Study of Untreated Syphilis in the Negro Male

One of the best-documented cases of unethical human medical experimentation in the twentieth century was the Tuskegee syphilis study. The Tuskegee Study of Untreated Syphilis in the Black Man (also known as the Tuskegee Syphilis Study, Pelkola Syphilis Study, Public Health Service Syphilis Study Medical ethics is primarily a field of Applied ethics, the study of Moral values and judgments as they apply to Medicine. The Tuskegee Study of Untreated Syphilis in the Black Man (also known as the Tuskegee Syphilis Study, Pelkola Syphilis Study, Public Health Service Syphilis Study The study took place in Tuskegee, Alabama and was supported by the Tuskegee Institute and the U.S. Public Health Service (PHS). Tuskegee University is a private, historically black university located in Tuskegee, Alabama, United States. Organization of the Public Health Service The Public Health Service Act placed the United States Public Health Service ( PHS) as the primary division ^[31]

The study began in 1932 using a group of 600 black sharecroppers. Sharecropping is a system of agriculture or agricultural production in which a landowner allows a tenant to use the land in return for a share of the crop produced on the land (e Of these 600, 399 of the men had the disease and 201 were uninfected control patients. The PHS stated at first that treatment was supposed to be a part of the study, but they were unable to produce any useful data. It was then discovered that the PHS had decided to leave the men untreated and follow the course of the disease to these men's eventual deaths. They thought they were receiving experimental treatment for "bad blood" in exchange for free meals and a $50 death benefit. However, the study was designed to measure the progression of untreated syphilis and to determine whether syphilis caused cardiovascular damage more often than neurological damage, and to determine if the natural course of the disease was different in black men versus white men. This is an article about the rock music band "Circulatory System" By 1947 penicillin had become the standard treatment of syphilis. The men were never advised that they had syphilis, nor were they offered a treatment including Salvarsan or the other arsenical drugs that were in use at the beginning of the study. Arsphenamine, also known as Salvarsan and 606, is a drug that was used to treat Syphilis and trypanosomiasis.

The original study was meant to last six to nine months, but continued for 40 years, ending in 1972, long after forty wives and nineteen children had been infected, and many of the men had died of syphilis. Year 1972 ( MCMLXXII) was a Leap year starting on Saturday (link will display full calendar of the Gregorian calendar. Twenty-eight men died directly from syphilis, and one hundred from other complications, during the study. The study ended because of a story printed in the Washington Star. The Washington Star, previously known as the Washington Star-News and the Washington Evening Star, was A class-action lawsuit was then filed against the federal government for the study. This lawsuit was settled out of court and the living subjects and their descendants were awarded a total of ten million dollars. After the settlement was awarded, the government passed the National Research Act, which required the government to review and approve all medical studies involving human subjects. The National Research Act was enacted by the 93rd United States Congress.

Syphilis in art and literature

Art

The artist Kees van Dongen produced a series of illustrations for the anarchist publication L'Assiette au Beurre showing the descent of a young prostitute from poverty to her death from syphilis as a criticism of the social order at the end of the 19th century. Cornelis Theodorus Maria van Dongen ( January 26, 1877 &ndash May 28, 1968) usually known as Kees van Dongen or just van Anarchism is a Political philosophy encompassing theories and attitudes which support the elimination of all compulsory Government, i The 19th century of the Common Era began on January 1, 1801 and ended on December 31, 1900, according to the Gregorian calendar

The artist Jan van der Straet, also known as Johannes Stradanus or simply Stradanus, painted a scene of a wealthy man receiving treatment of syphilis with the tropical wood guaiacum sometime around 1580. Giovanni Stradano or Jan Van der Straet or van der Straat or Stradanus or Stratesis was a Flanders -born mannerist ^[32] The title of the work is "Preparation and Use of Guayaco for Treating Syphilis. " That the artist chose to include this image in a series of works celebrating the New World indicates how important a "cure" (however ineffective) for syphilis was to the European elite at that time. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks. ^[33]

The Norwegian, Edvard Munch painted "The sins of the father", a portrayal of a horrified woman with her baby, covered in a rash and with a deformed face lying on a cloth across her knees. This was to portray congenital syphilis, presumably common at the time.

Classic and antique literature

Delicado also featured the effects of syphilis in his Portrait of Lozana: The Lusty Andalusian Woman (1528). The Portrait of Lozana The Lusty Andalusian Woman (original title in Spanish Retrato de la Loçana Andaluza) is a book written in Venice by the Spanish

There are references to syphilis in William Shakespeare's play Measure for Measure, particularly in a number of early passages spoken by the character Lucio. William Shakespeare ( baptised A play, or stageplay, is a form of Literature written by a Playwright, almost always consisting of Dialogue between Fictional characters Measure for Measure is a play by William Shakespeare, believed to have been written in 1603 or 1604 For example, Lucio says "[. . . ] thy bones are hollow"; this is a reference to the brittleness of bones engendered by the use of mercury which was then widely used to treat syphilis. Mercury (ˈmɜrkjʊri also called quicksilver or hydrargyrum, is a Chemical element with the symbol Hg ( Latinized hydrargyrum

In Shakespeare's play Othello, the clown at the beginning of Act III makes jest of Cassio, who is leading a musician troupe for Othello, by asking him if he had just arrived from Naples and playing with his nose. Naples ( Napoli, Neapolitan: Nàpule) is a historic City in southern Italy, the Capital of the (Alluding to the reputation of Naples of being a likely place to contract syphilis, which eats away at the bridge of the nose. )

It has been suggested that the main character in Edgar Allan Poe's "The Tell-Tale Heart" may have been infected with neurosyphilis, due to his strange obsessions and apparent insanity.

Francisco de Quevedo puns in his Buscón^[34] about a nose entre Roma y Francia meaning both "between Rome and France" and "between dull and eaten by the French illness". Francisco Gómez de Quevedo y Santibáñez Villegas ( Madrid, September 14, 1580 &ndash Villanueva de los Infantes, September 8, El Buscón (full title Historia de la vida del Buscón llamado Don Pablos ejemplo de vagamundos y espejo de tacaños (literally History of the life

Jonathan Swift's poetry mentions syphilis as a condition of prostitution which reaches the highest ranks of society. Jonathan Swift (30 November 1667 Prostitution is the act of performing Sexual activity in exchange for Money. See, for example, "A Beautiful Young Nymph Going To Bed" and "The Progress of Beauty".

Moll dies of syphillis, Hogarth's A Harlot's Progress.

William Hogarth's works frequently show his subject's infection with syphilis. William Hogarth (10 November 1697 &ndash 26 October 1764 was a major English painter, printmaker, pictorial satirist, social critic Two examples are A Harlot's Progress and Marriage à-la-mode. A Harlot's Progress (also known as The Harlot's Progress) is a series of six paintings (1731 now lost and engravings (1732 by William Hogarth In 1743–1745 William Hogarth painted the six pictures of Marriage à-la-mode ( National Gallery London) a pointed skewering of upper class 18th century In both instances it is used to indicate the moral profligacy of the infected.

Some critics have argued that the character of Edward Rochester's first wife, Bertha, in Charlotte Brontë's novel Jane Eyre, suffers from the advanced stages of syphilitic infection, general paresis of the insane, and point to corroborative evidence within the text to substantiate this view. Charlotte Brontë (ˈbrɒnti (21 April 1816 &ndash 31 March 1855 was a British Novelist, the eldest of the three famous Brontë sisters whose Novels Jane Eyre (dʒeɪn ɛə by Charlotte Brontë, published by Smith Elder & Company of London in 1847, is one of the most influential and

The novel Candide by Voltaire describes Candide's mentor and teacher, Pangloss, as having contracted syphilis from a maidservant he slept with; the syphilis has ravaged and deformed his body. --> Candide ou l'Optimisme (1759 is a French Satire by the Enlightenment Philosopher Voltaire, English translations of which François-Marie Arouet ( 21 November 1694 30 May 1778) better known by the Pen name Voltaire, was a French --> Candide ou l'Optimisme (1759 is a French Satire by the Enlightenment Philosopher Voltaire, English translations of which Pangloss explains to Candide that syphilis is 'necessary in the best of worlds' because the line of infection - which he explains - leads back to Christopher Columbus. Christopher Columbus (1451 &ndash May 20 1506 was an Italian Navigator, colonizer If Columbus had not sailed to America and brought back syphilis, Pangloss states, the Europeans would not have been able to enjoy 'New World wonders' such as chocolate. (One of the purposes of the novel was to satirize Leibniz's philosophy as Pangloss's disingenuous rose-tinted viewpoint. Satire is often strictly defined as a literary genre or form; although in practice it is also found in the graphic and Performing arts In satire human ) Pangloss eventually loses an eye and an ear to the syphilis before he is cured.

Also, in Charles Dickens' novel Tale of Two Cities, references are made that allude to the main character, Sydney Carton, having syphilis. A Tale of Two Cities (1859 is the second Historical novel by Charles Dickens, set in London and Paris before and during the Sydney Carton is a significant character in the novel A Tale of Two Cities by Charles Dickens.

In Eça de Queiroz's novel written in 1870, "The Mystery of the Sintra Road", some of the characters have syphilis, and it plays an important role in the plot of a recent movie adaptation. ^[35]

Henrik Ibsen's once-controversial play Ghosts has a young man who is suffering from a mysterious unnamed disease. "Ibsen" redirects here For other people named Ibsen see Ibsen (disambiguation. Ghosts (original Norwegian title Gengangere) is a play by the Norwegian Playwright Henrik Ibsen. Though it is never named, the events of the play make it plain that this is syphilis, an inheritance from his dissolute father. However, the young man's mother remains unaffected - this is because it is possible for a woman to carry syphillis and transmit it to her child in the womb without exhibiting any noticeable symptoms. Dr. Rank in Ibsen's play A Doll's House also has inherited syphilis. A Doll's House (literally translated A Doll's Home, from the original Norwegian title Et dukkehjem) is an 1879 play by the

Modern literature

Unnamed American medical students described syphilis in a series of early 20th-century American limericks, using medical terminology to ghastly comic effect in the Journal of the American Medical Association January 1942. JAMA The Journal of the American Medical Association is an international peer-reviewed general Medical journal, published 48 times per year by the American ^[36]

Thomas Disch in his novel Camp Concentration describe a fictional strain of syphilis that enhances intelligence but is lethal. Thomas Michael Disch ( February 2 1940 – c July 4 2008) was an American Science fiction author and Poet Camp Concentration is a 1968 Science fiction novel by Thomas M

In Thomas Mann's novel Doktor Faustus, the Faust character, Adrian Leverkühn, acquires his genius for musical composition from the neurological effects of syphilis. Paul Thomas Mann ( June Doctor Faustus (in German, Doktor Faustus) is a German novel written in the United States by Thomas Mann, begun in 1943

In Dick Francis' novel, Bonecrack the character Enso Rivera is suffering from megalomania caused by syphilis. Dick Francis CBE (born Richard Stanley Francis on October 31, 1920) is a British Author and retired Jockey. Megalomania (from the Greek word μεγαλομανία is a historical term for behavior characterized by Delusional fantasies of Wealth, power

Neal Stephenson's trilogy The Baroque Cycle has multiple characters and historical figures who have syphilis, most notably James II of England and Jack Shaftoe; the latter is cured of the disease by running a high fever. Neal Town Stephenson (born October 31, 1959) is an American writer known primarily for his Science fiction works in the Postcyberpunk genre The Baroque Cycle is a series of novels written by Neal Stephenson. James II of England and Ireland James VII of Scotland (14 October 1633 &ndash 16 September 1701 was King of England, King of Scots, Later that same year James Jack Shaftoe is a Fictional character featured in the novels of Neal Stephenson 's The Baroque Cycle.

In Leonard Cohen's second novel Beautiful Losers, the character F. Leonard Norman Cohen CC GOQ (born September 21, 1934 in Westmount, Quebec) is a Canadian Singer-songwriter Beautiful Losers is a Novel by Leonard Cohen. Published in 1966 by McClelland and Stewart, it was the Canadian novelist- is described in detail as having the terminal stages of syphilis.

In Christina Garcia's novel "Dreaming in Cuban," Felica contracts syphilis from her unfaithful husband. The syphilis and her family history lead Felica down a path towards insanity.

In Ken Follett's novel "A Dangerous Fortune," the wealthy Edward Pilaster contracts syphilis from his frequency of using brothels. Ken Follett (born June 5, 1949) is a British Author of thrillers and historical novels When Edward's cohort Micky Miranda finds out, it looks as though his diabolical plans may have a snag.

In Josilyn Jackson's novel "Between, Georgia", the protagonist Nonny Frett suffers from syphilis from a cheating husband she can't seem to rid herself of. Between is a town in Walton County, Georgia, United States. The population was 148 at the 2000 census

Film, Television and Stage

Syphilis is used as a plot device in many dramatic films, television shows, and plays. While some, such as the Warner Brothers film Dr. Ehrlich's Magic Bullet (1940), focus on the history of the disease, most involve late-stage syphilis because the neurological damage common to late-stage syphilis provides an excuse for strange behaviors. Warner Bros Entertainment Inc (or Warner Bros, Warner Bros Pictures) is one of the world's largest producers of Film and Dr Ehrlich's Magic Bullet is a 1940 Biographical film directed by William Dieterle and starring Edward G In recent years, syphilis has been mentioned on Grey's Anatomy, House M.D., Law & Order: SVU, Buffy the Vampire Slayer, Angel, and other television shows. Grey’s Anatomy is an American Primetime television medical drama. House, also known as House MD, is an American Medical drama, which debuted on the FOX network on November 16 2004 Law & Order Special Victims Unit (also known as Law & Order SVU or simply SVU) is an American Drama Fictional narratives (and works of art exist beyond their completion e Angel is an American Television series, a Spin-off of the television series Buffy the Vampire Slayer. A few particularly notable appearances include:

• Miss Evers' Boys is a 1992 stage play written by Dr. Miss Evers' Boys is a 1997 HBO television film starring Alfre Woodard and Laurence Fishburne, based on the true story of the decades-long David Feldshuh based on the true story of the decades-long Tuskegee syphillis experiment. The play was subsequently adapted into a 1997 HBO TV movie directed by Joseph Sargent and starring Alfre Woodard and Laurence Fishburne. Miss Evers' Boys is a 1997 HBO television film starring Alfre Woodard and Laurence Fishburne, based on the true story of the decades-long Joseph Sargent (born 22 July 1925, Jersey City, New Jersey) is an American Film director. Alfre Ette Woodard (born November 8, 1952) is an American actress. Laurence John Fishburne III (born July 30, 1961) is an American award-winning Actor of screen and stage, as well as The film was nominated for eleven Emmy Awards and won in four categories, including Outstanding Made for Television Movie.

• In Japanese director Akira Kurosawa's film The Quiet Duel (1949), Toshirô Mifune plays a doctor who gets infected with syphilis while operating on a soldier. is a 1949 Japanese film directed by Akira Kurosawa. Plot Toshirō Mifune (in the second of many films with Kurosawa plays a young idealistic Toshirō Mifune (ja 三船 敏郎 Mifune Toshirō toɕiɺoː 1 April, 1920 – 24 December, 1997) was a Japanese

• In big budget Spanish film Alatriste, the main character finds the love of his life, actress María de Castro, dying in a hospital for syphilitics. Alatriste is a film directed by Spanish director Agustín Díaz Yanes, based on the main character of a series of novels written by Arturo It is implied that she caught the disease from an affair with Philip IV of Spain. Philip IV (es ''Felipe IV'' pt ''Filipe III'' ( 8 April, 1605 &ndash 17 September, 1665) was King of Spain between 1621 and

• In the Masterpiece Theatre version of Bram Stoker's Dracula, Arthur Holmwood, whose father dies of syphilitic insanity, enlists the services of Count Dracula in hopes of curing his congenital syphilis. Masterpiece (formerly known as Masterpiece Theatre) is a drama Anthology television series produced by WGBH Boston. Abraham "Bram" Stoker (8 November 1847 – 20 April 1912 was an Irish writer of novels and short stories who is best known today for his 1897 horror Dracula is an 1897 novel by Irish author Bram Stoker, featuring as its primary Antagonist the vampire Count Dracula.

• In The Libertine, a 2004 film with Johnny Depp, the main character John Wilmot, second Earl of Rochester, is portrayed as having died of syphilis. John Wilmot may refer to John Wilmot 2nd Earl of Rochester (1647&ndash1680 English libertine friend of King Charles II and writer of satirical and bawdy

Historical studies

Amalia's Tale, published in 2008, is a study by David I. Kertzer about a poor peasant woman, Amalia Bagnacavalli, in the Italy of the 1890s. David I Kertzer is Paul Dupee Jr University Professor of Social Science Professor of Anthropology (1992&ndash) Professor of History (1992&ndash2001 and Professor of Italian Studies She was believed to have contracted syphilis from an infant child of a foundling hospital after serving as a wet-nurse for the baby. The book explores the story of a long court case and her lawyer Augusto Barbieri's untiring pursuit of compensation from that hospital on behalf of his client.

See also

• Tuberculosis (TB)
• Diphtheria
• Side-chain theory
• Paul Ehrlich
• Felix Milgrom
• Hideyo Noguchi Africa Prize -- May 2008

References

External links

• "Syphilis fact sheet" from the Center for Disease Control
• UCSF HIV InSite Knowledge Base Chapter: Syphilis and HIV
• "History of Syphilis" 14th Congress of the European Academy of Dermatology and Venereology (2005 "video" with no text for hearing-impaired people)
• "A New Gold Standard For Syphilis?" Poster Presentation for European Academy of Dermatology and Venereology 2004 Spring Symposium
• Kipkeepers, Pox and Gleet Vendors: A Rapid History of Syphilis
• Secrets of the Dead (PBS): The Syphilis Enigma
• Syphilis and AIDS: Lessons from history
• The treatment of dementia paralytica by malaria inoculation (A Nobel Prize lecture, December 13, 1927)
• New study blames Columbus for syphilis spread Reuters January 15, 2008
• Origins of Syphilis NYTimes April 29, 2008