An old nemesis returns

The midwife consulted me on a genital ulcer. Popped up weeks ago, more irritating than painful.

I saw the ulcer, clean-scooped like a shallow half-teaspoon. I knew what it was. Hesitated. Because I couldn’t recall the last time I’d seen a case.

The next day, a simple blood test confirmed my suspicion. Among a dozen possibilities, it was indeed syphilis.

The old nemesis. For centuries, it was blamed for the brutality, paranoia, madness and dementia of the powerful and the famous: Henry VIII, Ivan the Terrible, Oscar Wilde, Friedrich Nietzsche, Al Capone.

Synonymous with promiscuity. Everybody blamed everybody else. The Italians and Germans called syphilis the “French disease”; the French, "Neapolitan disease”; the Russians, “Polish disease”; the Polish, “German disease.” And everybody’s pissed off at Christopher Columbus, who supposedly brought it to Europe from the Americas.

And the medical misfires! Doctors rubbed, ministered, injected patients with mercury. Infused arsenic and sulfur. The 1927 Nobel Prize went to an Austrian physician who deliberately infected syphilitic patients with malaria for its fever effect.

It marked the nadir of U.S. medical ethics. In 1932, the public health sector started the "Tuskegee Study of Untreated Syphilis in the Negro Male" in Macon County, Alabama. Hundreds of African Americans with syphilis were recruited. None were informed of the study’s true intent: to observe the progression of untreated syphilis. Despite the availability of penicillin in the 1940s, none were properly treated. This project was terminated in 1972 after the Associated Press published a damning story.

I respect syphilis. Am humbled and awestruck by its sleek design, power and disguise. Dubbed the “Great Mimic,” syphilis manifests a plethora of symptoms in months, years, decades. If doctors don’t catch syphilis early, diagnosis becomes we-didn’t-even-think-of-it difficult.

Shaped like a corkscrew, the bacteria move like a diamond-tipped auger, striking nerves, eating cartilage and heart valves, eroding blood vessels and are capable of penetrating highly fortified sanctuaries like the brain, the womb ... infecting unborn babies. 

Skin lesions are the key to early detection and treatment. Syphilis usually starts as a painless genital ulcer(s), which heals spontaneously. Months later, a body rash may develop. These weird “pimples” may involve the palms and soles of feet. 

In the U.S., after decades of control, STD (syphilis, gonorrhea and chlamydia) rates have increased sharply. Since 2013, syphilis rose 76 percent.  

Meanwhile, other countries have made strides. In 2015, Cuba became the first country to eradicate mother-to-child HIV and syphilis transmission. The list now includes Thailand, Malaysia, six Caribbean countries.

To tackle STD, we need to get back to basics. Support public health organizations serving the underserved, like Planned Parenthood. Destigmatize syphilis – and all STDs. Remember “Life is sexually transmitted.”

I’m grateful for my midwife colleague. In my little corner of primary care, I don’t get to be a hero often. Guess what: Syphilis, sleek design and all, is still exquisitely sensitive to penicillin. One shot cures it.

I ordered the confirmation blood test. Then the penicillin shot for her. Another for her partner. I’m a hero, twice. Thrice, I fancy, if she has a child someday.