Syphilis is known by many names, including “great pox”, “French disease”, “Neapolitan disease”, “German disease”, “Spanish disease”, “Polish disease”, and even “Christian disease”, depending on the time period and culture involved. This is because people often have a xenophobic tendency to blame the transmission of infectious diseases on people from other countries .
Origins of the disease
There are few detailed records that can be used to definitively trace the origin of syphilis. However, various hypotheses have emerged over the centuries. Some of these are described below. [1,6].
- Pre-Columbian hypothesis: The pre-Columbian hypothesis maintains that the syphilis originated around 7,000 BC. According to this model, by about 3,000 BC, the bacteria that causes syphilis, which was endemic to Southwest Asia, emerged as a sexually transmissible disease due to the climate change that occurred during this time. It then spread to Europe and the remaining parts of the world. Adherents of this model believe that syphilis was once a mild disease whose virulence grew over time due to a number of deadly mutations.
- Unitarian hypothesis: The unitarian hypothesis advocates that syphilis and non-venereal treponemal diseases are different variants of the same infections. It further stresses that clinical variations are due to geographic, climatic, and cultural differences. For instance, Yaws, a non-venereal disease in Africa, is believed to have evolved into endemic syphilis in countries with cold and dry climates where personal hygiene is poor.
- Columbian hypothesis: According to the Columbian hypothesis, syphilis was brought to Europe from the Americas in 1493 by Christopher Columbus and his sailors. Documents belonging to Spanish physicians Fernandez de Oviedo and Ruy Diaz de Isla stand out as supportive evidence to back this theory. These physicians were present when Christopher Columbus returned from America. This theory has been disproved.
Several other theories tried to establish a connection between syphilis and leprosy. For instance, a tale from 16th-century Spain speculated that syphilis originated from a sexual relationship between a Spanish prostitute and a person with leprosy .
How Syphilis got its name
In 1530, Giraloma Fracastoro, an Italian physician and poet, was the first to coin the word “syphilis.” The name referred to a character in one of his books, ‘Syphilis Sive Morbus Gallicus’.
Evolution of diagnosis
Throughout the centuries, various attempts have been made to find a cure for syphilis. The first major breakthrough occurred in 1943 with the invention of penicillin, the world’s first antibiotic .
Until the 18th century, many physicians did not differentiate between sexually transmitted diseases. This makes it difficult for historians to definitively determine how many people in the past had syphilis. Below is a short history of the successes and failures in understanding, diagnosing, and treating syphilis.
- Differentiating from other STIs: In 1767, John Hunter, a venereal diseases specialist, used secretions from a patient with gonorrhea to infect a healthy patient. The healthy patient soon developed syphilis, which led Hunter to believe that syphilis resulted from gonorrhea. However, the person from whom the sample was taken was concurrently infected with both syphilis and gonorrhea. Hunter’s error hindered progress in understanding syphilis.
- Disease spread: In 1831, French venereologist Philippe Ricord made a few interesting observations regarding the spread of syphilis. He pointed out that people become infected when they came into physical contact with infected individuals.
- Causative agent: In 1905, Schaudinn and Hoffman discovered the etiologic agent of syphilis. It was initially named Spirochaeta pallida and was subsequently changed to Treponema pallidum.
- Microscopy: In 1906, Karl Landsteiner made use of the dark-field microscopy method for detecting the spirochete of syphilis.
- Blood test: The first serologic test to diagnose syphilis was introduced in 1910 by August Wasserman, a German bacteriologist.
- The TPI test: In 1949, Nelson and Mayer introduced the Treponema Pallidum immobilization (TPI) test, the first test explicitly used to detect the presence of T. pallidum. It has since become instrumental in confirming syphilis infections .
In 2016, the World Health Organization (WHO) developed a roadmap to eradicate STIs by 2021. One of their main focuses was eliminating congenital syphilis by improving screening and treatment, especially among pregnant women.
Their specific goals are listed here:
- Reduce the global incidence of syphilis by 90%.
- Bring the number of congenital syphilis cases worldwide to 50 (or less) per 100,000 live births in about 80% of countries by 2030 .