Penetrating Questions | Tolstoy contracted syphilis, and so could you

Jina Ashline Columnist

I heard there is a sexually transmitted disease that can make you go crazy. Is that true? And how can I avoid it?

-Spring Feverish

Dear Spring Feverish,

It is true! The disease you are referring to is syphilis, and not only can it cause insanity in its final stage, it also can cause blindness, heart disease, disfigurement and death. Syphilis is a scary sexually transmitted infection (STI) that was at one time more deadly than AIDS. It wasn’t until antibiotics to treat it were discovered in the 1940s that the number of cases of the disease began to decline. Unfortunately, in recent years the Center for Disease Control (CDC) has reported a dramatic increase in the disease. On average there are 35,000 new reported cases of syphilis per year, but the total number of cases of all stages of syphilis increased 11% between 2005 and 2006 and is on the rise each year.

Syphilis is caused by the bacterium Treponema pallidum that is shaped like a corkscrew, so it is also referred to as a spirochete. It has been called “the great imitator” because many of the symptoms of syphilis are indistinguishable from other diseases, particularly symptoms in the secondary phase. Some famous figures in history suspected of suffering from syphilis include Charles VIII, Ivan the Terrible, Hernando Cortez of Spain, Adolf Hitler, and Benito Mussolini. Some historians also suspect Friedrich Nietzsche may have become insane and died from the disease.

The origin of syphilis is unclear, but there are several theories. Although historians no longer think this theory is plausible, for a long time it was believed that Columbus brought syphilis to Europe from the West Indies. Supposedly, before his voyage, there were no recorded cases of syphilis in Europe, but when his crew returned, syphilis appeared and spread rapidly across Europe, killing many. It is true that syphilis killed its victims quickly during this time, but it eventually evolved to become the slow killing disease we know today.

Despite the fact that syphilis existed across Europe, no one country wanted to be associated with the disease, so it was known by many names. In Italy it was “the Spanish disease,” “the French disease” in Naples, “the Neapolitan disease” in France, and even “the disease of Española” (present day Haiti) in Spain. Eventually, the disease was named “syphilis” after a character in a poem written by Girolamo Fracastoro, an Italian physician in 1530. His poem was about a shepherd boy named Syphilis, who angered the god Apollo and was punished with the disease. Based on this poem, a new myth developed claiming syphilis originated after lonely shepherds became a little too friendly with their sheep.

Syphilis is spread through vaginal, anal, and oral sex, as well as kissing and skin contact during some stage. It can be contracted when oozing chancres (syphilis ulcers) are present in the early stage of the disease. The liquid in the chancres is very infectious and should not be touched! It cannot be contracted from toilet seats in public restrooms, despite some claims.

If left untreated syphilis can remain latent for many years or a lifetime, and it can spread from a pregnant woman to her fetus by passing through the placenta. The risk of stillbirth or serious birth defects (such as damage to the heart, brain, and skeleton as well as blindness, deafness, deformed teeth and bones) are high. Fortunately, there are drugs that can be taken to protect the fetus.
Syphilis is a complex infection because it has several phases that may overlap and do not always follow in the same sequence. Symptoms, when they appear, vary with each phase, but most people will not have any symptoms. Men have symptoms more often than women do, and only 10% of women who have symptoms notice them.

The Primary Phase includes painless sores or open, wet ulcers known as chancres. They are hard, round, ulcer-like lesions with raised edges, and they often appear two to four weeks after infection. They appear on the genitals, in the vagina, on the cervix, lips, mouth, breast, anus, on the labia, penis, or scrotum. These symptoms may disappear in a few weeks, but unless treated, syphilis is still present in the body.

The symptoms of the Secondary Phase often appear from a few weeks to a month after the chancres disappear. Symptoms include body rashes (with painless, reddish raised bumps that darken and burst) that are often on the palms of the hands and the soles of the feet and last two to six weeks. Other symptoms include mild fever, fatigue, sore throat, hair loss, weight loss, swollen glands, headache, and muscle pains. During this time people may mistakenly think they have the flu. The symptoms may come and go for up to two years.

The third stage is the Latent Phase. Symptoms do not occur because the disease lays dormant during this period. This stage can last for one to as many as forty years! The bacterium is still present and multiplies, spreading into the circulatory system, brain, spinal cord, and bones. The person may not be contagious to sex partners after several years into this stage, but pregnant women can still pass the disease on to their fetus during this period.

If syphilis is left untreated throughout the first two stages, the final stage, the Late or Tertiary Phase will eventually develop. A large ulcer may form on the skin, serious damage to the nervous system, heart, brain, skin, muscle tissue, digestive organs, lungs, liver or other organs, and death may result. “Neurosyphilis” can develop, causing brain damage, paralysis or mental illness. The damage to the brain syphilis can cause in this stage was once a common type of dementia called “general paresis.”

Due to the extreme symptoms and seriousness of the disease, early diagnosis and treatment is critical. Testing is done by microscopic examination of fluid from sores during the first stage. Blood tests can be done, but they are not definitive until the second stage. Testing of the spinal fluid is also an option.

Treatments for syphilis in the past included infecting patients with malaria (which cured the syphilis but left patients with a new disease), an arsenic treatment (from which Leo Tolstoy was cured of syphilis when he was young), and a mercury treatment (which is where the saying “A night in the arms of Venus leads to a lifetime on Mercury” comes from). Today, penicillin is very effective for treatment the disease.

The best way to reduce your risk for contracting syphilis is practicing sexual abstinence. However, because sexual abstinence is impractical for most people, it is critical to take steps to make sex safer. If you choose to have sex, be sure to get tested for syphilis and other STIs before having sex with each new partner. Insist your partner be tested as well. Do not assume your partner is disease free, especially since there often are no symptoms with syphilis.

Also, using latex condoms or dental dams (for oral sex or analingus) correctly and every time can lower your chance of contracting or passing on syphilis. While both partners can be successfully treated with antibiotics in the early stages, damage caused by syphilis in later phases is irreversible.

Since not everyone exhibits symptoms of syphilis, and condoms do not offer complete protection because it can be contracted from skin contact in places that condoms don’t cover, testing is very important. To get tested locally for syphilis, visit the Dutchess County Dept. of Health, 387 Main Street, First Floor, Poughkeepsie or call 845-486-3401. Visit cdc.gov for more information on syphilis and other STIs.