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The Origin of Syphilis — Still Controversial?

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The Origin of Syphilis — Still Controversial? 2012; 7(2): 127–130 UDK: 616.972(091) ISSN-1452-662X Istorija medicine @ivorad Marinkovi},1 Slobodanka \uki}2 THE ORIGIN OF SYPHILIS — STILL CONTROVERSIAL? Primljen/Received 26. 08. 2012. god. Prihva}en/Accepted 01. 10. 2012. god. Summary: Syphilis is a sexually transmitted dise- Syphilis is a fascinating and perplexing infection, ase caused by spiral-shaped bacterium, Treponema with protean clinical manifestations and both diagnos- pallidum The disease has been known under many na- tic and management ambiguities. It is usually transmit- mes during history, and has had a prominent role in his- ted sexually but congenital infections can occur and, in tory and literature for the last several hundred years. certain parts of the world, endemic nonvenereal disea- Since its recognition in 15th-century Europe as a new se due to T. pallidum exists (2). disease, syphilis has been the subject of great mystery The genus Treponema belongs to the order Spiroc- and legend. there are three main theories. These are the haetales, consisting of spiral-shaped pathogenic bacte- Columbian theory, the Pre-Columbian theory and the ria (Fig. 1). Other members of this order are the genera Evolutionary theory. The Columbian theory is most ac- Borrelia and Leptospira. Apart from T. pallidum sub- cepted. Syphilis exist nowadays, the World Health Or- species pallidum, the causative agent of venereal syph- ganization estimats that 12 million new cases of syphi- ilis, other pathogenic treponemes that cause disease in lis occur each year. While syphilis eradication seems a humans include T. pallidum subspecies pertenue, the biologically plausible goal, the major political, cultu- causative agent of yaws; T. pallidum subspecies ende- ral, and logistic difficulties involved make it unlikely. micum, the causative agent of endemic syphilis; and T. Regrettably, rather than become an infection of histori- carateum, the causative agent of pinta (3). cal significance, syphilis in the era of HIV continues to Controversy exists as to the historical origins of challenge researchers and clinicians. venereal syphilis. Key words: syphilis, history of medicine, sexually transmitted infection. INTRODUCTION The impact of emerging diseases on current medi- cine and society suggests there is value to understanding a disease that arose in Europe in the late 15th and early 16th centuries. Understanding how syphilis emerged, spread, and was “contained” by society may provide in- sights to fighting diseases such as AIDS today (1). Syphilis is a chronic sexually transmitted infec- tion caused by Treponema pallidum subspecies palli- dum. Syphilis has many synonyms. These include `the Great Pox’, Lues, the Great Mimic, the Great Imitator and Morbus Gallicus. 1 School of Medicine Zvezdara, Belgrade, Serbia 2 Institute of Microbiology and Immunology, Faculty of Medici- Figure 1. Spiral shaped bacteria ne, University of Belgrade, Serbia of the genus Treponema 128 @ivorad Marinkovi}, Slobodanka \uki} ORIGIN OF SYPHILIS The origin and antiquity of syphilis are among the greatest historical and scientific questions in the his- tory of medicine. Did Columbus and his crew bring syphilis from the New World to the Old World in 1493, as suggested by the timing of the first reported epidemic in Europe just years after their return? Or did syphilis originate in the Old World, simply going unrecognized until the early fifteenth century or, perhaps, noticeably increasing in prevalence or virulence at this time? There is considerable controversy regarding the origin of syphilis. However, there are three main theo- ries. These are the Columbian theory, the Pre-Colum- Figure 2. Christopher Columbo (1451–1506) bian theory and the Evolutionary theory (4). The commonly held belief is that syphilis, a gift of tion pressures with a new sexual transmission strategy. the New World to the Old, arrived in Spain with Co- Today, neither of the major competing hypotheses re- lumbus’ sailors in 1493 (Fig. 2). A minority contend garding the origin of syphilis assigns blame or makes that syphilis occurred in Europe before the Christian moral judgments upon Native Americans, as was sug- era and that Augustus Caesar, the first Roman Empe- gested by “The Syphilis Enigma” (8). ror, had hereditary syphilis (5). The Pre-Columbian theory implies that syphilis The troops of Charles VIII, King of France, who was present in Europe for several hundred years before marched to Naples in 1493, were probably infected by Columbus first returned from the New World. It is ba- soldiers of King Ferdinand of Naples, who had also hi- sed on the fact that European medical literature in the red mercenaries, among them soldiers from Barcelona 1200–1300s describes clearly certain forms of ’lep- in Spain. Many of the besieged gave up and succumbed rosy’ which were highly contagious and could be trans- to the French troops, who spread the disease on their mitted sexually and also from mother to child in-utero. way back north. Since 1495, the disease has appeared The Evolutionary/Unitarian theory is the least epidemically and spread explosively over the whole of well known of the three main theories. The Evolution- Europe (6). ary theory postulates that the different members of the Why was virulence so high when syphilis first ap- genus Treponema evolved from a single organism re- peared? We can speculate that the syphilis spirochaete sponding to changes in the environment. The original in the New World had evolved to an optimum virulence disease was probably pinta, which was prevalent in Af- in a coevolving host population with a variety of resis- rica and Asia (4). tance mechanisms. On introduction to a European host New data, instead of clarifying matters, contribute to population with none of these mechanisms in place, the an even more intricate scenario. For instance, osseous ev- pathogen would have been ’released’ from these con- idences of syphilis on pre-Columbian individuals from straints on virulence, and ironically was then more pat- Europe, point against a New World origin of syphilis, hogenic than necessary to give the highest fitness (7). while molecular data contradict the Unitarian hypothesis. Due to differences in climate, clothing, and sexual Consequently, although the issue has been discussed for practices, Renaissance Europe would have represented five centuries, the origin of syphilis is not yet clear (9). a very different environment than that present in His- It was soon recognized that different varieties of paniola, the location of Columbus’s first arrival in the treponemal disease exist. Unlike syphilis, which is ca- New World. The bacterium responsible for treponemal used by the spirochete T.pallidum subspecies pallidum, disease, Treponema pallidum, would thus have enco- the other types normally strike during childhood and untered a very new set of selective pressures upon arri- are transmitted through skin-to-skin or oral contact. val in the Old World. Perhaps it was exposure to this All are quite similar with regard to symptoms and pro- novel host environment that resulted in the birth of the gression, but endemic syphilis, or bejel, caused by T. pallidum subspecies that causes syphilis (T. palli- subsp. endemicum, has historically affected people liv- dum subsp.pallidum). Thus, in this modified Colum- ing in hot, arid climates and yaws, caused by subsp. bian hypothesis, Columbus and his crew could have pertenue, is limited to hot and humid areas. Pinta, cau- transported a New World, nonvenereal treponemal in- sed by Treponema carateum, is the most distinct mem- fection to Europe upon their return, which, once there, ber of this family of diseases. Once found in Central could have responded to dramatically different selec- and South America, this mild disease is characterized THE ORIGIN OF SYPHILIS — STILL CONTROVERSIAL? 129 solely by alterations in skin color. Today, the debate and relatively small in scope. One reason for this is the over the origin of treponemal disease encompasses ar- difficulty in obtaining nonvenereal strains for study. guments about whether the four infections are caused Today only five known laboratory strains of subsp. by distinct but related pathogens or one protean bacte- pertenue, two strains of subsp. endemicum, and no stra- rium with many manifestations (10). ins or samples of T. carateum survive. Furthermore, it The early names for the new disease reflected its is uncertain whether the disease pinta still exists. No origin and included the Spanish disease, the Neapoli- cases have been reported to the World Health Organi- tan itch (possibly coinfection with scabies), and the zation from the former endemic countries Mexico or morbus Gallicus. Colombia since 1979. Similarly, endemic syphilis was However, the name that was to become part of ev- eradicated some time ago in its European focus, Bo- eryday language was syphilis, derived from the title of snia. In Turkey, only one infected family has been re- an epic Latin peom Syphilis Sive Morbus Gallicus ported in the last forty years, and a large survey in the (syphilis or the French disease) by Girolamo Fracasto- United Arab Emirates revealed only non-active cases ro (1483–1553). This pastoral Latin poem became the of endemic syphilis in the elderly. In the Old World, most popular medical poem ever written and did much yaws is still reported but appears limited to a few isola- to spread knowledge of the disease across Europe. ted foci in the Republic of Congo and the Democratic In this poem, Syphilus, a shepherd boy who lives Republic of Congo, as well as Indonesia (10). in the time of King Acithous of Haiti, loses his sheep Another limitation on comparative studies has because of a drought. He blames the sun god and prop- been the small amount of variation present in the T. agates to render homage to King Acithous, rather than pallidum genome. it is possible that most polymorp- the sun god. The sun god took revenge by sending a hism in the T.
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