Medicine: Resurgent Syphilis: It Can Be Eradicated

Only five years after syphilis had apparently been conquered in the U.S. and was rapidly declining elsewhere, “the great pox” is making an unexpected comeback.

For the past two weeks agitated experts attending the World Forum on Syphilis and the International Congress of Dermatology in Washington have heard shocking estimates of the ravages of revitalized syphilis:

¶ Of 106 nations reporting to the World Health Organization, no fewer than 76 have a rising incidence of syphilis.

¶ In the U.S. the number of cases is still increasing. In the fiscal year that ended June 30, more than 4,000 babies were born with syphilis and at least 4.000 Americans died of it. There were also 124,188 cases reported for the first time.

But only 20,084 of these were truly new (in the infectious primary or secondary stages of the disease), and these probably represented only half of the actual total.

Almost 20,000 cases had gone unreported (and therefore, usually, untreated) for up to four years, and 80,000 for an even longer period of time.

¶A staggering 9.000.000 Americans are estimated to have syphilis, or to have had it at some time in their lives; probably 1,200,000 are now suffering from untreated syphilis.

Frail Germ. What makes these woeful numbers so astonishing is that syphilis is completely preventable, and in its earlier stages is completely curable with inexpensive penicillin. More remarkable, as Dr.

William J. Brown of the U.S. Government’s Communicable Disease Center pointed out, the spirochete of syphilis is “about as frail as a germ can be and still survive.” So delicate that it can be cultivated only with difficulty in laboratory animals and hardly ever in the test tube, it flourishes nowhere but in the body of man.

Even there, the spirochete can stand so little heat that artificial fever was once a treatment for syphilis. The germ gets no free ride on food, air, water, or from insects. It can attack a new victim only through the most intimate contact, and then only during a relatively brief time.

Yet during 450 years, syphilis has slaughtered and maimed millions, blinded and deafened them or driven them mad, crippled babies in the womb, and ruined the lives of millions of dependents who had no direct contact with it.

Dr. Brown hammered away at the 20,000 known new cases and 4,000 deaths annually in the U.S. If there had been only one-fourth as many cases of disease and death due to smallpox, typhus, plague or malaria, he said, there would have been virtual panic: “All the medical and public health resources of the nation would have been mustered.” Why had syphilis been allowed to make such a comeback after the near knockout of the 19503? Dr. Brown answered his own question:

“As a program for the control of a disease approaches the end point, meaning eradication, it is not the disease but the program that is the more likely to be eradicated.” Federal as well as state and municipal funds for venereal disease were reduced in the ’50s when syphilis appeared to be beaten.

The resurgence of syphilis is partly due to a remnant of the traditional hush-hush attitude toward venereal diseases. Only 5% to 10% of today’s youngsters learn anything about VD from their parents, and many learn little more in school.

Teenagers, either ignorant or overconfident, account for much of syphilis’ increase. The historic spread through female prostitution has been largely replaced by spread through careless “goodtime girls” and male homosexuals — especially male prostitutes.

Some doctors, said Dr. Harry Pariser of Norfolk, Va., are too much influenced by “;a clean-cut appearance and an air of prosperity or social prominence” in a patient, and thus fail to order a blood test.

More than a quarter-century after premarital blood-testing was adopted in Connecticut, said Manhattan Psychologist Hugo G. Beigel, “there are still several states where candidates from all over the country can be married without this precaution.” In three chivalrous states, only the bridegroom has to have the test.

Rapid Check. The symptoms of syphilis are so various, said Dr. Pariser, that a physician may confuse syphilis with acne, chicken pox, measles, mononucleosis or cancer. He estimated that from 40% to 60% of syphilis victims pass through the primary and secondary stages without knowing what has hit them. Then the spirochete goes underground, to erupt at intervals over the years in new active phases. Finally, in about half of the untreated cases, it attacks the heart and aorta, the brain and spinal cord. If the victim does not die of heart disease, he may end his days as a lame, blind, insane, partially paralyzed patient in a mental hospital.

The famed Wassermann test for syphilis and others like it take about two hours or more, and all require more laboratory equipment than can be toted into a backwoods area. At the Washington meetings, the U.S. Public Health Service’s Dr.

Joseph Portnoy described a new and simplified test which its developers claim is truly portable and fast. Called the RPR (for Rapid Plasma Reagin) card test, it requires only three drops of blood, obtained by pricking the subject’s finger.

The blood does not have to be centrifuged or heated. After the red cells settle out, the plasma is transferred to a dimpled card, reagents are added, and the result of the test can be read with the naked eye instead of a microscope. The process takes only five to eight minutes.

Here to Stay. Even with sensitive diagnostic tests and penicillin for treatment, a massive campaign must still be waged to wipe out the disease. Doctors will be urged to report all cases of syphilis to health authorities, who will interview the patients and track down their contacts.

(This has worked well in areas where health officials have made it clear that the information will never reach the police.) Laboratories, it is proposed, should be compelled to report all positive reactions. Once bitten by overoptimism, the VD crusaders are now doubly shy of any letdown. There must be no cutback in funds, they insist, until the great pox is really conquered. Dr. Brown warned that as cases become fewer, finding them will become harder—and perhaps more costly.

Said Psychologist Beigel: sex is here to stay, but syphilis need not be.