In 1900 Sir William Osler was known as “The Father of Modern Medicine.” He had a famous quote that went: “He who knows syphilis knows medicine.” The meaning of that was that the symptoms syphilis could produce were so varied.
Penicillin came on the scene and pretty much wiped out the disease. It wound up being on the back burner for many years. However, it is now making a comeback. In the year 2000 there were a total of about 31,000 total cases in the U.S.
That number increased every year since then. By 2014 it had doubled to over 63,000 cases. It doubled again over the next five years to almost 130,000 cases. By 2022 it had risen to over 207,000 cases. That equals about 1 case for every 1,600 Americans that year.
About half of those cases are in young adults between the ages of 15 and 24 years of age. They think syphilis is something of the past. They feel they have no need to worry about it.
Unfortunately, it is no longer 1900. In those days physicians knew what to look for. They had seen so much of it. The diagnosis was obvious.
A parallel example is related to the fact that I was trained before measles vaccine had just about wiped out the disease. I could walk into a room and look at a patient and say he had measles when I opened the door. Many younger physicians have never seen a case of measles.
The same is true for syphilis. It is often not on the list of things that the doctor thinks about. However, since it can cause such a wide variety of symptoms, it should be included more often.
Primary syphilis results in a genital wound that heals in 3 – 6 weeks. The patient may ignore it as just a sore.
After a period of time that might take weeks to months, the patient can then develop what is called secondary syphilis. It can cause headache. It can cause malaise. It can cause poor appetite. It can cause joint pains. It can cause a rash. It can cause swollen lymph nodes. In other words, it can look like almost any other kind of infection.
About one out of 20 of those patients can have it affect the nervous system. It can cause vision changes. It can cause seizures. It can cause neuropathy in the extremities. It can cause an altered mental state.
The final stage is called tertiary syphilis. It can occur many years after the initial infection. It can cause inflammation of the aorta. It can cause degeneration of the spine. It can cause general muscle weakness. It can cause soft tissue tumors that can appear anywhere in the body.
Clearly the symptoms can be multiple. They can also be anywhere. They can present a confusing picture. As the number of cases continue to grow, we may learn that Sir William Osler is still right.