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IRA FLATOW, host:
You're listening to SCIENCE FRIDAY. I'm Ira Flatow.
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Unidentified Man: The alphabet has only 26 letters. With these 26 magic symbols, however, millions of words are written every day.
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FLATOW: Of course, that means it's time for this month's episode of Science Diction where we explore the origin of scientific words.
And this month, we have a special extended edition because not only does the word syphilis have an interesting history rooted in the Italian Renaissance, but the origins of the disease are pretty mysterious themselves. No one really agrees where it came from, when the first cases were reported or appeared, and the condition itself is fascinating to physicians because it's caused by a very evasive tricky little creature. We promise not to gross you out.
Dr. Howard Markel is professor of the history of medicine at the University of Michigan in Ann Arbor. He's also director of the Center for the History of Medicine there.
Welcome back, Howard.
Dr. HOWARD MARKEL (University of Michigan): Good afternoon, Ira.
FLATOW: You're welcome.
Dr. Peter Leone is a professor of medicine at the University of North Carolina in Chapel Hill. He's also chair-elect of the National Coalition of STD Directors. He's also on the phone.
Welcome to SCIENCE FRIDAY.
Dr. PETER LEONE (University of North Carolina): Thank you, Ira.
FLATOW: Good to have you back.
Howard, tell us how the term syphilis came about. Where does it come from?
Dr. MARKEL: Well, it really was a beloved literary character that was created by an eminent physician, poet and professor named Hieronymus Fracastorius. And he did this in 1530 when he wrote an epic poem called "Syphilis Sive Morbus Gallicus" or what's also known as "Syphilis or the French Disease." And he wrote a poem about this mythical shepherd named Syphilis who rejected and then insulted the sun god. And in response, the deity struck him down with the dreaded malady, and that's where the name comes from.
FLATOW: Wow. And, Dr. Leone, can you walk us through the various stages of infection when you get syphilis?
Dr. LEONE: Well, syphilis is an interesting organism because - or disease because it mimics many other diseases. So there are three stages to infection.
The first stage occurs about one to three weeks after someone may be exposed to and infected with syphilis. It may take actually up to three months before we actually see signs. And a person develops what we call primary syphilis. They get a sore or a lesion at the site of inoculation. That's called a chancre. It usually doesn't hurt, although some of the pictures of it you would think it hurts quite a bit.
Because it doesn't hurt, many folks either don't recognize it, don't see it, because it depends on the location or treat, and, of course, it clears and goes away.
Untreated, you haven't gotten rid of syphilis, you just get pass the first stage, and then they go into what we call the second stage or secondary syphilis. That's where the organism breaks out at a local area, spreads throughout the body. Usually, there's low-grade fever with that, a rash. You can get swollen lymph nodes. People may get what we call patchy alopecia and inflammation of organs like the liver and kidney.
Again, untreated, that stage goes away, and then they enter into a long latent period in which the organism really doesn't turn over much but can cause long-term disease.
Before, about 15 percent of folks go on to what we call tertiary syphilis or this third stage of syphilis secondly to things like aortic aneurysm and CNS disease, so dementia and nerve damage as well as, what we don't see much of anymore, gummatous disease which are lesions involving bone and soft tissue.
FLATOW: It sounds awful, but I guess the good news is that it's easily curable if you catch it.
Dr. LEONE: It is. I mean, we've had effective therapy for syphilis for 60 years. It's penicillin. We don't see resistance to penicillin, but we haven't been able to eliminate this organism in the U.S. or internationally.
FLATOW: Dr. Markel, in the early days of testing penicillin, American doctors deliberately infected hundreds of Guatemalans with syphilis, something that just recently...
Dr. MARKEL: Yeah.
FLATOW: ...came to light, did it not?
Dr. MARKEL: It recently came to light. A historian named Susan Reverby at Wellesley College was the one who uncovered that. She was looking at papers of a man named John Cutler who was the physician in charge of that. He later became associated with another infamous syphilis study, the Tuskegee study.
But in this experiment that was done between 1946 and 1948, there were, you know, hundreds, 700 Guatemalans - prison inmates, soldiers and mental patients - who were deliberately inoculated with syphilis.
Shocking, under any circumstances to a 21st century observer, but especially so because of the years, because 1946 is also the year when penicillin is widely available. And so it's on so many levels unethical and problematic, and that only makes it more so.
And so when this was uncovered in October - last fall, you know, a very different thing happened with the response of, say, Tuskegee or earlier scandals is that the Secretary of State, Hillary Clinton, and then President Obama immediately apologized on behalf of the United States for such a study. And the president ordered a full commission investigation by the National Bioethics Commission, the presidential commission on bioethics, which should report of their findings. They had a charge of nine months and they started in January of this year. So we should expect something from - a lot more fully about this in September.
FLATOW: Do we know, Howard, where syphilis originated?
Dr. MARKEL: One of the great questions of the history of medicine. And you could separate the world of historians of medicine to two fronts: those who believe Christopher Columbus and his band of sailors went to Hispaniola, the Dominican Republic and Haiti today, where they not only discovered but probably raped and pillaged and brought back that infection of syphilis with them from the New World to the Old World.
Now, there are some interesting chronology because right - a few years after that voyage, it starts breaking out in places like Italy and Spain and all across Europe, in France and so on. And a lot of - you can trace a lot of people to the Columbian travels, discovery.
And the syphilis they were seeing back then were incredibly acute and abrupt and gross and deadly in a very short period of time in quite distinction to the modern stage definition that was just discussed. And so these people developed serious skin lesions that were very gross to look at, as well as had rather rapid death. And so this was the pandemic, if you will, of certainly Fracastorius' this time, but all throughout the Renaissance.
FLATOW: Hmm. Doctor Leone, where do you come out on this one?
Dr. LEONE: Well, I'm Italian-American, so that's my disclaimer. And I certainly don't blame the Italians. But I think there's actually pretty compelling evidence now that this was a, quote, unquote, "New World disease" that was brought back to the Old World. Although it's interesting that there are some debate whether or not the organisms that eventually led to T. pallidum, which is the organism that causes syphilis, may have pre-dated in East Africa. And when the slave trade went to Asia, and then from Asia back to North America, where over time we wound up having T. pallidum develop in syphilis. So, you know, we're all interconnected. It just took a lot longer for things to get transmitted from continent to continent back then.
FLATOW: What I find interesting is that some research just out this week and in the recent days showing an outbreak of syphilis among seniors, you know, the baby boomers.
Dr. LEONE: Well, we continue to see outbreaks in the U.S. In fact, we hit a historical low in 2000. The CDC had ruled out a syphilis elimination plan in 1999. Our medical director for HIV and STD in the state of North Carolina - we were involved with that plan. We hit an all-time low in about 2002, but the rates have come back up in the U.S. And so we've seen increases in older Americans, and in particular, among men who have sex with men.
In 2008 to 2009, in North Carolina, we had a doubling of our cases of syphilis. About half of the new cases in men were also HIV co-infected. Through a lot of efforts here, we've seen about a 20 percent decrease in those numbers. And we continue to see decreases this year. But it's a concern in that this is an organism that's very tricky and we continue to see transmission and outbreaks even in the U.S.
FLATOW: Howard, do you think that the disease is different today than it was in past, maybe less virulent, even though it's showing its ugly head again now?
Dr. MARKEL: You know, it has always a remained its ugliness in its virulence. But I think if you're using these - and their narrative descriptions. We don't have blood tests or DNA evidence or anything we would use. Whereas my old pathology professor would always say, get the tissue before you make the diagnosis. But it sounds like these original cases in the late 1490s and all throughout the 1500s, particularly the early years, were very - more severe or abrupt and could have been caused by a different organism or a combination of organisms. We just don't know.
And that's right, the other part of that syphilis equation, in terms of Columbus, is the pre-Columbian theory, that it was not, you know, a new disease at all. So, you know, there are just so many mysteries about this disease -past and present and future.
FLATOW: And how do they - how do the people back then - how do they deal with syphilis back in the Renaissance, the days before the antibiotics? What were...
Dr. MARKEL: Well, you know, you can always round up the usual suspects in Renaissance medicine; bleeding is a big one, but also anything else that could change what were construed as the problem with the four humors. So they might do some cupping, which is using these hot cups to draw out negative humors. They might have given you a medics or purgatives. But the treatment was, you know, limited at best, and people who got sick generally died.
But, you know, up until 1940s, in the United States, say in 1939, 64,000 Americans died of syphilis. So it was a serious disease that killed a lot of people well up to the middle of the 20th century.
FLATOW: And Doctor Leone, why doesn't our immune system just detect the bacteria...
Dr. LEONE: Well, the...
FLATOW: ...and get rid of it.
Dr. LEONE: Yeah. We - there is some debate whether or not there may be some partial immunity that may protect an individual from acquiring syphilis shortly after acquisition. And if you look at the trends in the U.S., there's about a 10-year cycle where the numbers go up and then they come down. And it's pretty consistent in terms of this 10-year periodicity.
The belief is that there may be some, basically, low-level herd immunity. But people can get re-infected. And the reason for that is the organism itself has a lipid out or layer of fatty acid covering most of the protein so that when it actually presents to the immune system there is not very many proteins that the body can respond to. And as a result, we don't get protective antibodies to syphilis and we don't clear it. And then the organism likes to hide out in immune-protected sites, like the central nervous system. So a lot of the longer term diseases that we see related to untreated syphilis or because those sites are somewhat protected from an immune response.
So it's a tricky organism. It's been smart. We don't have a vaccine for it. But we still have effective therapies. And, you know, the big debate is why we continue to see it in the U.S.
FLATOW: And what would your guess be why if it's - people just don't know to look for it maybe.
Dr. LEONE: Well...
FLATOW: They don't know - they don't think they could get it or it's, you know, we don't talk about it very much. Because if you can just simply get a penicillin shot and get rid of it, you'd think that people would say, OK, I'll just go get one.
Dr. LEONE: Boy, you would think, but we don't do the job talking about sex or sexuality in the U.S. So when you have a disease like syphilis that has a pretty horrid history associated with it and a lot of stigma, people don't necessarily walk in with their doctors and say, hey, I think I have syphilis. In addition...
FLATOW: Let me just interrupt for a second and say, are doctors looking for it?
Dr. LEONE: No, and that's the problem is that not only aren't physicians presenting - are patients presenting, but physicians aren't even thinking about it. And because the signs and symptoms could be mistaken for other infections and diseases, they may not test for it.
So we are really trying to raise awareness. And I'm actually glad you're doing this program today because our syphilis numbers in the U.S. have gone up. And in particular, this is a problem because of the association of syphilis with HIV.
FLATOW: Yeah, you did mention those statistics being higher. 1-800-989-8255 is our number. You know, in some diseases, in viruses sometimes, there's a reservoir that may hang out in the birds. You know, we heard of - or swine flu or avian flu, things like this. Does syphilis infect other animals, where it may incubate and attack us?
Dr. LEONE: No.
FLATOW: Is that right?
Dr. LEONE: No. So this is a human disease, which is why we can talk about elimination; which really, again, comes back to the question you raised, Ira, about why aren't we getting rid of it. And I think it's because when we're dealing with syphilis, we've taken a medical approach to it or our idea has been that we should just be able to test and treat. That assumes everyone has equal access to care, which we know isn't true. That assumes that clinicians think about it and will treat when they first see signs and symptoms, which is not true.
But we also ignore the fact that the reason it persists has to do with all the what we call contextual factors that allow folks to actually engage in activities that put them at risk and also create economic situations which they may not have health care.
FLATOW: We're talking about syphilis this hour. I'm Ira Flatow. This is SCIENCE FRIDAY. I'm Ira Flatow.
Yeah, it's just I'm flabbergasted to hear the statistics, that this is, you know, not being talked about. It's on the rise. It's easy to get rid of it once you have it. But, yeah, it's persistent. And we need to talk about it some more, I guess.
Dr. LEONE: I think we do need to talk about it. You know, it's funny that we've had, I think, two conversations in the past month, one about herpes and one about syphilis.
We need more dialogue. And I think we're trying to, again, raise awareness about this. But also, the communities that are impacted have been so marginalized, whether we are talking about men who have sex with men or minority communities. I mean, Tuskegee still plays a big shadow on the land around our efforts to try to eliminate this disease. And, of course, internationally there are issues around access to care.
FLATOW: Mm-hmm.
Dr. LEONE: So I think until we begin to deal with the underlying issues there, we can kind of keep a lid on the numbers. I mean, our numbers in the U.S. are a lot lower than what they were post-World War II. We're averaging about 13,000 or 14,000 cases of infectious syphilis a year right now. But it is alarming that it's going up.
FLATOW: Well, Howard, you know, some pretty famous died from complications from syphilis. Maybe if we've started saying if these people died from it, you might also.
Dr. MARKEL: Well, that's one approach. It's ironic, though, we're talking about we don't talk enough about it. In 1934, Franklin Roosevelt's Surgeon General, Thomas Parran, was set to go on CBS and talk about syphilis, and they would not allow him to say that word over the radio in that era. So there's all sorts of discomfort that we have in our past and present about talking about it. But you're right, there's lots of famous people.
You know, Scott Joplin, the ragtime king, died of it, Al Capone, Toulouse-Lautrec. Probably, the most notorious was Guy de Maupassant, the great French writer and I would say derelict, who not only contracted syphilis but said, at last, I have the real thing, and then went on to have sex with six prostitutes in front of his friends. So lots of very irreverent behavior among some of the famous victims of this terrible disease.
FLATOW: Maybe we can end and go and come full circle at the beginning. Can you read a little bit of a poem to us?
Dr. MARKEL: Absolutely. It's such a wonderful poem. But here's the part where the real action happens.
(Reading) The all-seeing sun no longer could sustain these practices, but with enraged disdain darts forth such pestilential malignant beams, as shed infection on air, earth and streams. From whence this malady it's birth received. And first, the offending syphilis was grieved. Who raised forbidden Altars on the hill, and victim's blood with impious hands did spill. He first wore buboes, dreadful to the sight, first felt strange pains and sleepless past the night. From him, the malady received its name.
FLATOW: Well, all right, well, I think we've given it a little bit of sunlight today.
Dr. MARKEL: Or the sun god may have done that, I'm not sure. I'm going to respect him.
FLATOW: All right. Thank you, doctors. Howard Markel, professor of the history of medicine at University of Michigan in Ann Arbor and director of the Center for the History of Medicine there. And Peter Leone is professor of medicine at the University of North Carolina in Chapel Hill, chair-elect of the National Coalition of STD Directors. Have a good holiday weekend. Thank you for joining us.
Dr. LEONE: All right. Thank you, Ira.
Dr. MARKEL: Have a nice weekend, Ira.
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