SYPHILISAPRIL 8, 2010

http://www.bium.univ-paris5.fr/sfhd/musee/image12.htm

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/)

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

Phylogenic and bone evidence confirm that Syphilis arose in the New World

Origins of Syphilis

6 Suite101.com: Skeletons – London’s Buried Bones

Epidemiology

Low burden, even in the third world Most US cases among men, especially MSMs

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

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

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…

Transmission Contact with sores only (not via tub, utensils, toilets, etc)

Relatively safe…relatively: Not so much:

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)

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…

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)

Attachment Can attach to wide variety of cells and extracellular

matrix proteins Don’t know how.

Super powers

always do the trick.

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)

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.

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)

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)

Used to use Mercury or Malaria co-infection

Archaic Treatment

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

Recurring Can be re-infected with syphilis even after successful

treatment

Prevention Abstinence or condom (somewhat)

I pity the fool who don’t wrap

his tool.

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