While unwelcome, it is somehow fitting that syphilis, a medieval infection that had virtually disappeared, is making a comeback.
It is, after all, a disease with a tortured history, associated with xenophobia, bigotry, racism and warmongering, which are also on the rise. Syphilis is also easily preventable and treatable, but the number of cases is soaring nonetheless, fuelled, paradoxically, by scientific and technological advances in an era when distrust in science is on the rise.
Could there possibly be a more symbolic affliction in these Trumpian times?
Last week, the headlines were about an outbreak of syphilis in Alberta. But rates are also soaring all over the developed world, including the in United States and across Europe, Japan, Australia and elsewhere.
As with all infectious diseases, marginalized communities such as Indigenous peoples and men who have sex with men are hit hardest. Syphilis is caused by the bacterium Treponema pallidum, a sexually transmitted infection that can be spread by oral, genital or anal contact. The first symptoms, chancres, are easy to miss.
Historically, it is one of the most stigmatized, disgraceful illnesses known to man, associated with promiscuity, bohemianism and other liberal, irreligious attitudes. The origins of syphilis are unclear and hotly disputed. One theory holds that it has been around since 15,000 BC, spreading and mutating like other treponemal diseases such as yaws, bejel and pinta.
The more widely promoted theory is that syphilis was brought to Europe from America by Christopher Columbus and his crew. That’s because, in 1495 (two years after Columbus returned from his first voyage), an epidemic broke out among French soldiers who invaded Naples, and subsequently spread across Europe, then to Africa and Asia, usually starting in war zones.
Traditionally, countries blame neighbouring (or enemy) states for outbreaks. In Germany and England, syphilis was known as the French disease; Russians called it Polish disease; in India, Muslims blamed Hindus, and vice versa.
For centuries, sexually transmitted infections such as syphilis and gonorrhea were commonplace, and the symptoms were gruesome and often fatal. The makeshift remedies were often as bad, or worse, than the illness. Syphilis, for example, was treated with mercury, and patients often succumbed to mercury poisoning.
After the bacterium was identified in 1905, the treatment switched to a derivative of arsenic. It was not until the discovery of penicillin and its broad availability in the early 1940s that syphilis became easily and effectively treatable, and it remains so to this day.
Yet, even after treatment was available, there were some horrific experiments, such as the Tuskegee study, in which hundreds of African-American men with syphilis were left untreated for 40 years (1932-72) so researchers could track symptoms of the disease.
Today, as with many infectious diseases, it is on the prevention side of the equation where we’re failing. There is a variety of theories about why syphilis rates are soaring: The popularity of hookup apps such as Grindr and Tinder; condom fatigue; reduced fear of HIV; and increases in sex under the influence as binge drinking and use of party drugs increases.
They probably all play a role, but you can also poke holes in each of those claims. For example, rates of syphilis are rising way faster than gonorrhea or chlamydia, all of which can be prevented by condom use. While hookup apps are popular, studies show that, over all, younger people are delaying having sex and have fewer sexual partners.
The data show that the rise of syphilis cases is primarily among men who have sex with men. But, again, this is a group whose members tend to get tested routinely, so that can be misleading. There is also evidence that men infected with HIV and treated with anti-retrovirals could be more susceptible to infection with syphilis.
In other words, there is a complex intermingling of factors that we don’t fully understand.
What we do know is that, as has been the cases for centuries, it is those with the most sexual contact who are most at risk of contracting syphilis, and it is those who are untreated who suffer the greatest harm. (Pregnant women are especially at risk because the bacterium can cause stillbirths and causes deformities to the fetus.)
Instead of fretting about outbreaks of syphilis and looking for individuals or specific groups to blame, we need to arm people – especially sexually active young people – with the tools to protect themselves, including sex education and easy access to condoms.
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André Picard