Articles from prior issues of The Advocate

November/December, 1995

The Evolution of Sexually Transmitted Diseases
by Rebecca Calvert, BRADE

DID YOU KNOW KING CHARLES IV played a significant role in the syphilis outbreak of the late 1400’s? He hired mercenaries in 1484 to invade Naples. After the mercenaries conquered Naples, they were instructed to wait for King Charles IV to arrive before leaving the area and returning to their homes. During the long and boring wait, they entertained themselves with the camp followers. Needless to say, it was a time of sexual excess and considerable debauchery. By the time King Charles arrived at the end of the year, many of the soldiers were suffering from “THE GREAT POX” which looked similar in manifestation to Smallpox. When the soldiers returned to their respective homes, the disease was dubbed “The French Disease” as many of the mercenaries were French in origin. Syphilis is still referred to as “The French Disease” by some today.

Many misconceptions prevailed regarding the cause of syphilis in the 1400’s. Women were blamed as carriers of the disease since one common belief held that the menstrual cycle caused the lesions. Treatment at that time consisted of avoiding public baths, avoiding kissing and breast feeding, burning myrrh, purging and applying mercurial ointments to the affected areas. Neurological toxicity sometimes resulted from the treatment with mercury rather than from the disease itself. Many people at that time also believed this disease was a Divine Intervention punishing man for his sins. (Does this sound like a familiar belief held by some regarding AIDS today?) Syphilis may have been present in earlier times. For instance, Job’s ulcers and bone pain sound similar to syphilis symptoms. However, the epidemic among the soldiers of the 1400’s is the earliest recorded epidemic of a sexually transmitted disease.

Many different and controversial treatment methods were used in the attempt to cure or control syphilis over the years including mercury, arsenic and other experimental drugs until penicillin was finally used as a treatment method during World War II. Syphilis reached its peak prior to the introduction of penicillin as a treatment method in 1943 when approximately 540,000 cases were recorded. Syphilis showed a steady decline through the 1970’s when the recorded number of cases was approximately 50,000. The 1980’s once again saw an increase in the number of cases of syphilis as well as a change in the presentation of the disease. Syphilis symptoms today usually consist of one large pimple which may or may not be visible or a very transient rash. The symptoms have become more tertiary since 1991 with a significant increase in cognitive and neurological symptoms. A patient in his/her 20’s or 30’s who presents with symptoms suggestive of a CVA are very often diagnosed positive for syphilis. Such symptoms may include antigrade amnesia, difficulty performing tasks, vague weakness in the extremities or cognitive slowing.

In 1984 the incidence of HIV cases decreased in the gay community while the incidence of HIV cases in the heterosexual community increased. Dr. Goffin indicated in his presentation that some schools of medical theory maintain that syphilis does not exist without the presence of HIV and vice versa. HIV encephalopathy is sighted as an example of the relevance of this theory. Other symptoms of tertiary syphilis which may arise include metabolic difficulties, retinopathy, peripheral neuropathies, Bell’s Palsy and hearing loss in isolated cases. In fact, Dr.Goffin related an incident where a 70 year old female patient presented with isolated hearing loss of abrupt onset, and the physician struggled with delicately broaching the subject of any history of sexually transmitted diseases. He finally asked the patient if she had ever been treated for “bad blood” and indeed the patient had been treated for syphilis many years in the past. Her hearing returned to normal after following a normal treatment cycle with penicillin.

Dr. Goffin related that a matter of great concern to the medical community at this time is the pattern of latency of sexually transmitted diseases such as syphilis. A period of latency, which may last seven to eight years, can emerge and present an even deadlier form of symptomology. He cited examples of current tertiary symptoms similar to multiple sclerosis and other multifocal progressive neuropathies. Dr.Goffin is the Chief Medical Officer at the Maine DDS, and we were very fortunate to have such a knowledgeable and entertaining speaker at our conference.