Despite the well recorded history of Syphilis, its origins remain shrouded in mystery. It was the first “new” disease to be discovered after the invention of printing with the first recorded outbreak in 1495 in the city of Naples. There continued to be large outbreaks recorded across Europe and several continents, but by the early 18th century syphilis had become more of the episodic disease we see today. The disease was commonly called “lues”, “syph”, or the “pox.
In 1905, the bacteria that caused syphilis, Treponema pallidum, was finally discovered. The following year in 1906, the first test for diagnosing syphilis was developed called the “Wassermann Reaction”. Previously doctors were only able to diagnose the infection if a patient had symptoms. Unfortunately, this was not a foolproof diagnosis method, as syphilis has many stages that are symptomless.
Early treatments for syphilis were few and difficult, and often included harmful substances, including mercury. Mercury had terrible side effects including neuropathies, kidney failure, severe mouth ulcers, and loss of teeth – many patients died of mercury poisoning rather than syphilis. Treatment typically continued for years, and gave rise to the saying, ‘a night with Venus (goddess of love), and a lifetime with Mercury’. When doctors realised how toxic mercury was, they looked for other treatments, however none were effective.
It wasn’t until 1910 that the first effective treatment of syphilis was developed – an arsenic compound called Salvarsan, followed by Neo-Salvarsan in 1912. It was later shown that for arsenic to be effective it had to be combined with small doses of either mercury or bismuth. This treatment was used until Penicillin was introduced in 1943.
This was a turning point in syphilis treatment, as Penicillin is highly effective when used in the primary or secondary stages of syphilis and has few side effects when compared to mercury or arsenic. Penicillin remains the mainstay of syphilis treatment.
Rates of syphilis infection varied before the discovery of Penicillin. Australia’s peak infection rate was in 1920, when there were 173.1 cases per 100,000 population. These rates decreased after the introduction of Penicillin, reaching the lowest rate in 1990 of 9.6 cases per 100,000 population. But since the 1990s syphilis rates have started to rise again worldwide. Australia has also seen infectious syphilis rates rise; there were 20.3 cases per 100,000 population in 2018.
So, if we can easily and successfully treat syphilis why is this old disease making a big comeback? There are several reasons:
- Men who have sex with men (MSM) are at greatest risk of acquiring syphilis infection, but syphilis is being spread more broadly in the population and affecting previously lower risk groups such as heterosexual males, females and babies (passed from mother during pregnancy). This is partly due to sexual-network-bridging between men who have sex with men (MSM) and heterosexual women.
- The rise of apps such as Tinder and Grindr mean sex is more readily available and more anonymous, helping people hook up more efficiently than ever before.
- A decrease in condom use, which has been partly linked to the rise in apps, successful HIV treatment and the advent of PrEP.
- Reduced number of easy access sexual health clinics. In many countries, easy access sexual health clinics have had their funding cut, and this has reduced the number of clinics open, or reduced the opening hours of the remaining clinics.
So, while we can now say ‘a night with Venus, and a short time with Penicillin’ it is important that we prevent the resurgence of this ancient and invisible disease.
