This article reviews the major theories existing in the literature, which provide an explanation with respect to the origins of the disease known to all as syphilis. The clinical manifestations, transmissibility, and treatment of this disease vary throughout the natural history of the infection and can be explored further in the disease tab.
Syphilis, is a sexually transmitted disease, caused by Treponema pallidum, which has a tumultuous history and has posed a threat to humans for many centuries. The major controversies on the origins of syphilis are examined in the literature, which assume three hypotheses, two of which relate exclusively to the European issue.
The first hypothesis is called the Columbian hypothesis and recognizes syphilis as a contagion from the New World, after the discovery of America conveyed by the Spaniards who participated in the expeditions of Christopher Columbus; the second hypothesis concerns a mutation of another treponematosis already present in Europe, called the pre-Columbian hypothesis. The third hypothesis, the least recognized one, suggests that syphilis was transported from the Old World to the New World.
The Columbian hypothesis originated in 16th-century Spanish tales, and was popularized by Crosby (1969). He proposes that syphilis originated in the New World and was transmitted to the Old by Columbus in 1492. This is supported by 15th- and 16th-century evidence of the rapid spread and extreme virulence of syphilis in the early years of the epidemic, which some have argued suggests a new infectious disease unleashed on virgin populations. Indeed, a kind of immunity had been noted in Mayan populations who seemed to be addicted to the bacterium. The tribal women of this people had an attenuated form of syphilis until the arrival of the Europeans, a time when the bacterium assumed greater virulence even for Native Americans.
They also had an attenuated form of syphilis until the arrival of the Europeans.
In contrast, the pre-Columbian hypothesis states that the disease was present in the Old World before 1490. It was a very mild disease or one that was indistinguishable from other bone remodeling diseases, particularly the one known as "venereal leprosy."
According to this theory, historical accounts indicating the emergence of a new disease in the 15th century may be attributed to an increase in the virulence of the disease or to better medical and lay recognition of syphilis perhaps due to the introduction of the printing press or a particularly virulent New World strain.
Different researchers have given this explanation an anthropological and evolutionary twist by proposing that the sexually transmitted treponemal disease evolved in response to the social, cultural, and environmental changes that humans have experienced since the Pleistocene, such as increased population density and urbanization.
The presence of congenital infection is widely regarded as evidence for the existence of siphilis venerea in a given region and time period. Among others, Merbs (1992) and Erdal (2006) pointed out that its presence is crucial to confirm the existence of pre-Columbian Old World syphilis. This is because, due to treponematoses, only syphilis is routinely transmitted transplacentally.
According to the last hypothesis, treponematoses are environmentally determined expressions of a unique and extremely flexible disease, with syphilis being a product of improved hygiene, which hindered the skin-to-skin transmission of endemic treponematoses, as well as lax urban sexual mores (Hudson, 1963, 1965). Following initial criticism, this theory has been discredited by genetic evidence showing that the three treponemal subspecies are genetically distinct and have evolved along different trajectories.
It is well known that syphilis, has always been imputed as a stigmatized and shameful disease, each country whose population was affected by the infection blamed the epidemic on neighboring, and sometimes enemy, countries. In Italy, beginning in 1494, the year of Charles VIII's invasion, syphilis took the well-known name French disease; in France they called it Napolitan disease; the Spaniards male of the Germans; the Danes, Portuguese, and people of North Africa conferred the disease on the Spaniards; and the Turks coined the term male of the Christians.
The term "syphilis" was used to describe the disease in the United States.
The term "syphilis" was then introduced by Girolamo Fracastoro, a poet and physician from Verona. His work "Syphilis sive Morbus Gallicus" (1530) comprises three books and features a character named Syphilus, who was a shepherd leading the flocks of King Alcihtous, a character from Greek mythology. In Fracastorus' account, Siphilo, angry at Apollo for burning trees and consuming the springs that fed the shepherds' flocks, vowed not to worship Apollo but his king. Apollo took offense and cursed people with a disease called syphilis, named after the shepherd. The affliction spreads to the entire population, including King Alcithous. The nymph Ammerice advises the inhabitants to offer further sacrifices to Apollo, one of which is Siphilus himself, and also to sacrifice to Juno and Tellus, the latter offering the people the Guaiacus tree (Guaiacum officinale), a therapeutic medicine widely used in Fracastorus' time.
The first treatments and the discovery of penicillin
.In 1906 Landsteiner, introduced the use of the dark field microscopy method for the detection of the syphilis spirochete. In 1910, German bacteriologist August Wasserman (1866-1925) came along with the first serological test for syphilis, and in 1949 Nelson and Mayer devised the Treponema pallidum immobilization test (TPI), the first specific test for Treponema pallidum.
Their findings have played a very important role in detecting the disease in patients suspected of having syphilis, as well as in other healthy individuals, and in monitoring the response of syphilis to treatment.
German scientist Paul Ehrlich (1854-1915) received the Nobel Prize in Physiology and Medicine in 1908 for his discovery of arsfenamine (Salvarsan). The scientist discovered the compound that behaved like an antibiotic by accident, while working to find a cure for Trypanosoma brucei.
Ehrlich's desire was to discover a "magic bullet," a drug that could bind specifically to a bacterium and kill it, without affecting human cells. Salvarsan was also named "Compound 606," as it was discovered after 606 failed experiments (Tampa et al., 2014). The safer new drug that replaced the more toxic and less water-soluble Salvarsan as a treatment for syphilis was Neosalvarsan, also an arsenic compound. Both Salvarsand Neosalvarsan were replaced in the treatment of syphilis by penicillin, after 1940.
In fact, in 1928, Alexander Fleming (1881-1955) discovered penicillin, and by 1943 it became the main treatment for syphilis.
Finally, examining the evolution of the disease, one can see how easy it has been to stigmatize not only individuals affected by the disease, but also entire nations, as throughout history countries have been blamed for the spread of the disease.
Throughout the centuries, syphilis has affected individuals from a variety of backgrounds, from monarchs, painters and philosophers to people from the lower class. Over the centuries, several treatments for the disease have been tried. Today, penicillin and prevention programs make it possible to control the spread of the disease.
Bibliography
Brothwell D. (1981). Digging up bones: the excavation, treatment and study of human skeletal remains. London: British Museum of Natural History.
Brothwell D. (2005). North American treponematosis against the larger world picture. In: Powell M, Cook D, editors. The myth of syphilis: the natural history of treponematosis in North America. Gainesville, University Press of Florida, 480-497.
.Buret F. (1891). Syphilis today and among the ancient.
.Castiglioni A. (1941). A history of medicine.
Erdal Y. 2006. A pre-Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD) 16, 16-33.
.Hackett C. (1963). On the origin of the human treponematoses (pinta, yaws, endemic syphilis and venereal syphilis). Bull World Health Organ 29, 7-41.
.Hackett C. (1981). Development of caries sicca in a dry calvaria 391, 53-79.
.Harper K.N., Zuckerman M.K., Harper M.L. (2011). The origin and antiquity of syphilis revisited: an appraisal of Old World pre-Columbian evidence for Treponema infection 146, 99-133.
Knell J. R. (2004). Syphilis in renaissance Europe: rapid evolution of an introduced sexually transmitted disease? 271(4), 174-S176.
Mays S. (1998). The archaeology of human bones. London: Routledge.
Merbs C. 1992. New world of infectious disease. 35, 3-42.
Rothschild B.M (2005). History of Syphilis. Clinical Infectious Diseases 40, 1454-1463.
Steinbock R. (1976). Paleopathological diagnosis and interpretation.
Sudhoff K. (1925). The earliest printed literature on syphilis: being ten tractures from the years 1495-1498.
.
Tampa M., Sarbu I., Matei C., Benea V. & Georgescu S.R. (2014). Brief History of Syphillis 7(1), 4-10.
.Walker P. (2008). Bioarchaeological ethics: a historical perspective on the value of human remains. In: Katzenberg M, Saunders S, editors. Biological anthropology of the human skeleton, 3-41.
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