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SYPHILISAPRIL 8, 2010
http://www.bium.univ-paris5.fr/sfhd/musee/image12.htm
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Origins of Syphilis First unambiguous
case of syphilis recorded in 1495
From New World
The Faster Times “Travel’s With “Lapham’s Quarterly”: Christopher Columbus Will Trade Cotton For Gold, 1493” (http://thefastertimes.com/slowtravel/2009/11/05/travels-with-laphams-quarterly-christopher-columbus-will-trade-cotton-for-gold-1493/)
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Treponema pallidum pallidum Other, non-syphilitic, T. pallidum
subspecies existed in the Old World Humanity has been evolving with T.
pallidum for at least 1.5 million years
Origins of Syphilis
Wikipedia: Yaws
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Phylogenic and bone evidence confirm that Syphilis arose in the New World
Origins of Syphilis
6 Suite101.com: Skeletons – London’s Buried Bones
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Epidemiology
Low burden, even in the third world Most US cases among men, especially MSMs
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Primary 10-90 after infection Chancres
Symptoms
USC School of Medicine’s Microbiology and Immunology on-line: Bacteriology – Chapter 14 (http://pathmicro.med.sc.edu/fox/spiro-neisseria.htm)
USC School of Medicine’s Microbiology and Immunology on-line: Bacteriology – Chapter 14 (http://pathmicro.med.sc.edu/fox/spiro-neisseria.htm) 3
Secondary Skin rashes and mucosal lesions Rarely, more severe symptoms
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Tertiary Symptoms Gummatous lesions in various organs and of the body Cardiovascular Syphilis Neurosyphilis
Asymptomatic Meningovascular General Paresis of the Insane Tabes Dorsalis
Symptoms
Baylor University: Leishmaniasis: Visceral or Kala-Azar, Cutaneous, and Mucocutaneous Leishmaniasis (Espundia) (http://www.wynman.com/baylor.html)
Latent Symptoms None…it’s latent Can lay dormant for up
to 20 years
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Congenital Can be transmitted from mother to child Causes severe developmental abnormalities,
spontaneous abortion, and or postnatal death
Symptoms
All of the pain, none of the pleasure…
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Transmission Contact with sores only (not via tub, utensils, toilets, etc)
Relatively safe…relatively: Not so much:
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Treponema pallidum pallidum Spirochaete phylum
Wadsworth Center. New York State Department of Health. “Disease Carriers: Bacteria: Treponema pallidum (http://www.wadsworth.org/databank/treponem.htm)
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It’s a weak little bugger Can’t be cultivated in vitro for long Oxygen and heat susceptible
Can’t do genetic modifications Usually cultivated in rabbits
All of the pain and no--…
well…
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Lack Type III Secretion Mechanism and cytotoxins
Lack of Virulence
Pacific Northwest National Library (http://www.pnl.gov/science/highlights/highlight.asp?groupid=853&id=566)
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Attachment Can attach to wide variety of cells and extracellular
matrix proteins Don’t know how.
Super powers
always do the trick.
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Invasion Stimulate production of matrix metalloproteinase 1
(MMP-1) Can subsequently invade multiple tissue types
T. pallidum
Modified from German Cancer Research Center in the Helmhotlz Association (http://www.dkfz.de/en/tumorzellinvasion/research/Tumor_Cell_Invasion.html)
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Immune Escape Lacks lipopolysaccharides (LPS) Can invade privileged tissues and organs Slow metabolism and little need for iron
…mostly your genitals and various organs, but same idea.
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TprK proteins: Prime antigenic targets made of several variable (v) sections between constant (c) sections Phase Variation and recombination Involved in forming lesions
Immune Escape
The Institute of Cancer Research Picture Gallery 2 (http://www.icr.ac.uk/research/research_sections/structural_biology/teams/barford_team/picture_gallery_two/6913.shtml)
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Diagnosis Dark Field Microscopy Nontreponemal Tests
Venereal Disease Research Laboratory (VDRL) Rapid Plasma Reagin (RPR)
Treponemal Tests Fluorescent Treponemal Antibody Absorption (FTA-ABS)
Prep4md: August 2008 (http://prep4md.blogspot.com/2008_08_01_archive.html)
Brookside Associates: OB-GYN 101 Lab – “RPR/VDRL/MHA-TP (Serologic Tests for Syphilis)Darkfield/FTA-ABS Microscopy” (http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Lab/RPR.htm)
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Used to use Mercury or Malaria co-infection
Archaic Treatment
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Modern Treatment Penicillin and other β-Lactam Antibiotics9
Intramuscular shot(s) Jarisch-Herxheimer Reaction
Treat with acetaminophen
Doxycyclin or tetracycline otherwise Antipsychotics can be used to treat certain neurosyphilis symptoms
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Recurring Can be re-infected with syphilis even after successful
treatment
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Prevention Abstinence or condom (somewhat)
I pity the fool who don’t wrap
his tool.
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References1. Beltrami J, Weinstock H, Berman S, Et Al . 2006 Mar. Primary and Secondary Syphilis --- United States, 2003--2004. CDC
Morbidity and Mortality Weekly Report [serial online]. 55(10):269-73. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5510a1.htm.
2. CDC. 2010. Syphilis - CDC Fact Sheet. Atlanta, GA: Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm.
3. Clancy N. 2010. The History of Syphilis. Gainesville, FL: University of Florida. Available from: http://medinfo.ufl.edu/other/histmed/clancy/.
4. Disease and injury country estimates. Geneva, Switzerland: World Health Organization. Available from: http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html.
5. Hall CS & Bolan G. 2010. Syphilis and HIV. San Francisco, CA: University of California at San Francisco. Available from: http://hivinsite.ucsf.edu/InSite?page=kb-05-01-04.
6. Harper KN, Ocampo PS, Steiner BM, George RW, Silverman MS, et al. (2008) On the Origin of the Treponematoses: A Phylogenetic Approach. PLoS Negl Trop Dis 2(1): e148. http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000148
7. Jamess R B. 2010. Syphilis. Health.am. Available from: http://www.health.am/sex/syphilis/.
8. LaFonda RE, Lukehart SA. 2006. Biological Basis for Syphilis. Clinical Microbiology Reviews 19(1):29-49.
9. Lee V, Kinghorn G. 2008. Syphilis: An Update. Royal College of Physicians: Clinical Medicine 8(3):330-3.
10. The Medical News: Syphilis History. The Medical News. Available from: http://www.news-medical.net/health/Syphilis-History.aspx.
11. MetaPathogen.com: Treponema pallidum subsp pallidum. 2009. Available from: http://www.metapathogen.com/syphilis/
12. Rose, M. (1997). Origins of Syphilis. Archaeology, 50(1). http://www.archaeology.org/9701/newsbriefs/syphilis.html