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C a r o l D av i l a U n i ve r s i t y o f M e d i c i n e a n d P h a r m a cy, B u ch a r e s t - Ro m a n i a

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J o u r n a l o f M e d i ci n e a n d L i f e Editor-in-Chief: Florian Popa
Volume 7 Issue 1 January-March 2014 ''Carol Davila'' University of Medicine
and Pharmacy Bucharest, Romania

Editorial Board
Adrian Streinu-Cercel, Carol Davila University of Medicine Ioanel Sinescu, Carol Davila University of Medicine and
and Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Andy Petroianu, Federal University of Minas Gerais, Belo Kypros Nicolaides, Kings College Hospital, London, U.K.
Horizonte, Brazil
Bogdan Ovidiu Popescu, Carol Davila University of Medicine Ladislau Steiner, University of Virginia, Charlottesville, VA,
and Pharmacy, Bucharest, Romania U.S.A.
Brian T. Pickering, University of Bristol, U.K. Luigi Frati, La Sapienza University of Rome, Rome, Italy
Madjid Samii, Medical University of Hannover, Hannover,
Christos Kittas, University of Athens, Greece Germany
Eliot Sorel, George Washington University School of Medicine, Miron Bogdan, Carol Davila University of Medicine and
Washington D.C., U.S.A. Pharmacy, Bucharest, Romania
Tudorel Ciurea, Craiova University of Medicine and
Emil Toescu, University of Birmingham, Birmingham, U.K. Pharmacy, Craiova, Romania
Executive Editor
Victor Lorin Purcrea,"Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania
Scientific Council
Leon Wegnez, A.I.D.A. Brussels, Brussels, Belgium Marius Boji, Iuliu Haieganu University of Medicine and
Pharmacy, Cluj, Romania
Theodor Purcrea, Romanian-American University, Bucharest, Mircea Diculescu, Carol Davila University of Medicine and
Romania Pharmacy, Bucharest, Romania
Ion Ababii, Nicolae Testemieanu University of Medicine and Ion Fulga, Carol Davila University of Medicine and
Pharmacy, Chiinu, Republic of Moldavia Pharmacy, Bucharest, Romania
Valeriy Zaporozhan, Odessa State Medical University, Odessa, Ecaterina Ionescu, Carol Davila University of Medicine and
Ukraine Pharmacy, Bucharest, Romania
Silviu Constantinoiu, Carol Davila University of Medicine and Ioan Lascr, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Vlad Ciurea, Carol Davila University of Medicine and Mircea Penescu, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Gabriela Radulian, Carol Davila University of Medicine and Dan Andronescu, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Alexandru Cioclteu, Carol Davila University of Medicine and Mircea Beuran, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Victor Stoica, Carol Davila University of Medicine and Constantin Copotoiu, Tg. Mure University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Tg. Mure, Romania
Petre Bordei, Ovidius University, Constana, Romania Adriana Sarah Nica, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania
Crina Sinescu, Carol Davila University of Medicine and Virgiliu Ancr, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Dafin Mureanu, Iuliu Haieganu University of Medicine and Dan Mischianu, Carol Davila University of Medicine and
Pharmacy, Cluj, Romania Pharmacy, Bucharest, Romania
Drago Stanciu, Carol Davila University of Medicine and Dumitru Borun, National School of Politic and Administrative
Pharmacy, Bucharest, Romania Studies, Bucharest, Romania
Constantin Zaharia, Carol Davila University of Medicine and Dana Minc, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Mugurel Constantin Rusu, Carol Davila University of Gheorghe Orzan, Academy of Economic Studies, Bucharest,
Medicine and Pharmacy, Bucharest, Romania Romania
Virgiliu Arion, Carol Davila University of Medicine and Ion Srbu, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Dumitru Lupuliasa, Carol Davila University of Medicine and Gelu Onose, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Ana Maria Vldreanu, Carol Davila University of Medicine Petrior Geavlete, Carol Davila University of Medicine and
and Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania
Doina Pleca, Carol Davila University of Medicine and Nica Dan Aurel, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania Pharmacy, Bucharest, Romania

Editorial Members
Assistant Editors Publishing Editors
C. Poiana G.D. Petrescu R. Costea P. Radu C.M. Gheorghe E.M. Pahontu
Consulting Student Editors
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Journal of Medicine and Life
Volume 7 Issue 1 January-March 2014

Table of contents
Efforts to enhance the quality of life 1
Purcarea VL
R e vi ew s 4
Brief history of syphilis
Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR
Intraocular pressure after phacoemulsification in patients with uncontrolled primary open angle glaucoma 11
Iancu R, Corbu C

Original Articles
Translating clinical research of molecular biology into a personalized, multidisciplinary approach of colorectal cancer 17
patients
Strambu V, Garofil D, Pop F, Radu P, Bratucu M, Popa F
27
Pilonidal sinus: a comparative study of treatment methods
Varnalidis I, Ioannidis O, Paraskevas G, Papapostolou D, Malakozis SG, Gatzos S, Tsigkriki L, Ntoumpara M, Papadopoulou A,
Makrantonakis A, Makrantonakis N

General Articles
Hepatitis C treatment & management 31
Andronescu D, Diaconu S, Tiuca N, Purcarea RM, Andronescu CI
Osteoarthritis pathogenesis a complex process that involves the entire joint 37
Man GS, Mologhianu G
Phenotypic spectrum and hormonal profile in hypogonadotropic hypogonadism 42
Pun D, Gherlan I, Popescu I, Procopiuc C, Dumitrescu C, Brehar A, Dinu D, Neamtu C, Poiana C, Dumitrache C

Case Presentations
Role of MRI in the diagnosis and evauation of cavernous hemangioma of the arm 46
Ciurea ME, Bondari S, Stoica LE, Gheonea IA
A study of the effect of cardiac rehabilitation on heart failure patients life quality 51
Ghanbari-Firoozabadi M, Rahimianfar AA, Reza Vafaii Nasab M, Namayandeh SM, Emami M, Boostani F, Sherafat A, Barzegar K
Correlation between macular changes and the peripapillary nerve fiber layer in primary open angle glaucoma 55
Manasia D, Voinea L, Vasinca ID, Alexandrescu C
Postoperative surgical complications of lymphadenohysterocolpectomy 60
Marin F, Plesca M, Bordea CI, Voinea SC, Burlanescu I, Ichim E, Jianu CG, Nicolaescu RR, Popa TM, Maher K, Blidaru A
Self harm through foreign bodies ingestion rare cause of digestive perforation 97
Petrea S, Brezean I
Non-steroidal anti-inflammatory drug induced transient reactive papulotranslucent acrokeratoderma 75
Orzan OA, Popa LG, Voiculescu V, Manta R, Giurcneanu C
78
Ankylosing spondylitis functional and activity indices in clinical practice
Popescu C, Trandafir M, Bdic AM, Morar F, Predeeanu D
Prognostic scoring systems - validation and their utility in patients with abdominal sepsis in colon peritonitis 84
Teleanu G, Iordache F, Beuran M
The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular 90
Mavrodin CM, Pariza G, Ion D, Ciurea M

Special Articles
Bipolar plasma vaporization versus monopolar TUR and cold-knife TUI in secondary bladder neck sclerosis an 94
evidence based, retrospective critical comparison in a single center clinical setting
Moldoveanu C, Geavlete B, Jecu M, Stanescu F, Adou L, Bulai C, Ene C, Geavlete P
Psychological factors mediating health-related quality of life in COPD 100
Popa Velea O, Purcarea VL
Conscience and consciousness: a definition 104
Vithoulkas G, Muresanu DF
Young researchers area
Solutions for medical databases optimal exploitation 109
Branescu I, Purcarea VL, Dobrescu R
 Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014, pp.4-10

Brief History of Syphilis

Tampa M*, Sarbu I**, Matei C*, Benea V**, Georgescu SR*
*Dermatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest
**Dermatology Department, Victor Babes Hospital for Infectious and Tropical Diseases, Bucharest

Correspondence to: Mircea Tampa, MD, PhD, Assistant Lecturer

Sos. Mihai Bravu 281, 3rd District, Bucharest, Romania
e-mail: tampa_mircea@yahoo.com
phone: 0726382600

Received: September 14th, 2013 Accepted: January 14th, 2014

Abstract
Before the discovery of Treponema pallidum as the etiologic agent, the origins of syphilis have been the subject of several debates.
Diverse therapeutic agents were employed in an attempt to cure the disease. Examining the milestones in the history of syphilis, the
present article reviews the existing theories that tried to explain the origins of the disease, the approach in art, the cultural and the
evolution of the treatments from the empiric means to the discovery of penicillin.

Keywords: syphilis, syphilis treatment, history of syphilis

Introduction
Syphilis is a sexually transmitted disease caused
by Treponema Pallidum, a bacterium classified under
Spirochaets phylum, Spirochaetales order,
Spirochaetaceae family, but there are at least three more
known species causing human treponemal diseases such
as Treponema pertenue that causes yaws, Treponema
carateum causing pinta and Treponema pallidum
endemicum-responsible for bejel or endemic syphilis. The
four members of the bacterial family cannot be
differentiated with morphological, chemical or
immunological methods [1,2]. Of the aforementioned
bacteria, syphilis is the sole sexually transmitted
treponemal disease, as the other conditions are
transmitted via direct contact with an infected individual
[3].
From the very beginning, syphilis has been a
stigmatized, disgraceful disease; each country whose
population was affected by the infection blamed the
neighboring (and sometimes enemy) countries for the
outbreak. So, the inhabitants of todays Italy, Germany
and United Kingdom named syphilis the French disease,
the French named it the Neapolitan disease, the
Russians assigned the name of Polish disease, the
Polish called it the German disease, The Danish, the
Portuguese and the inhabitants of Northern Africa named
it the Spanish/Castilian disease and the Turks coined the
term Christian disease. Moreover, in Northern India, the
Muslims blamed the Hindu for the outbreak of the
affliction. However, the Hindu blamed the Muslims and in
the end everyone blamed the Europeans [4-6].
In the 16th century, Jean Fernelius, a Parisian
teacher whose work and interests were channeled into
the mercury treatment of the condition, coined the term
lues venera (venereal pest) in his treaty dedicated to
the affliction [7]. Therefore, the term syphilis was
introduced by Girolamo Fracastoro, a poet and medical
personality in Verona. His work Syphilis sive Morbus
Gallicus (1530) encompasses three books and presents
a character named Syphilus, who was a shepherd leading
the flocks of King Alcihtous, a character from Greek
mythology. In Fracastoros tale, Syphilus, mad at Apollo
for parching the trees and consuming the springs that fed
the shepherds flocks, vowed not worship Apollo, but his
King. Apollo gets offended and curses people with a
hydious disease named syphilis, after the shepherds
name. The affliction spread to the whole population,
including King Alcithous. The nymph Ammerice counseled
the inhabitants to offer Apollo further sacrifices, one of
which was Syphilus himself, and also to sacrifice to Juno
and Tellus, the latter offering the people the tree of
Guaiac (Guaiacum officinale), a very used therapeutic
medicine in times of Fracastoro [6-8].
Hypotheses on the origin of syphilis
The pre-columbian hypothesis. The advocates of
this hypothesis claim that not only syphilis was widely
spread in both Old and New World, but also the other
treponemal diseases. In Europe, most of these conditions
were mistaken for leprosy [3]. According to this
hypothesis, pinta occurred in Afro-Asian zone by the year

15.000 BC, having an animal reservoir. Yaws appeared
as a consequence of the mutations in pinta around 10.000
BC and spread allover the world, except for the American
continent which was isolated. The endemic syphilis
emerged from jaws by the selection of several
treponemas, as a consequence of climate changes (the
appearance of the arid climate) around 7000 BC. Around
3000 BC the sexually transmitted syphilis emerged from
endemic syphilis in South-Western Asia, due to lower
temperatures of the post-glacial era and spread to Europe
and the rest of the world. Initially it manifested as a mild
disease, eventually aggravated and grew in virulence,
suffering from several mutations, at the end of the 15th
century [2,3].
The unitarian hypothesis. Considered by some
authors as a variant of the pre-Columbian hypothesis, it
advocates that the treponemal diseases had always had a
global distribution. According to this theory, both syphilis
and non-venereal treponemal diseases are variants of the
same infections and the clinical differences happen only
because of geographic and climate variations and to the
degree of cultural development of populations within
disparate areas. Briefly, pinta, yaws, endemic syphilis and
venereal syphilis are considered as adaptative responses
of T. Pallidum to changes in the environment, cultural
differences and contact between various populations
[3,9]. In this respect, yaws had a starting point in Central
and Western Africa, spreading towards the Iberian
Peninsula along with the capturing and selling of Africans
as slaves, fifty years before Columbus voyage. Yaws,
endemic in Africa for that time being, would have
remained unmodified in countries with similar climate
conditions as those in the origin countries, but would have
evolved into endemic syphilis in countries with colder and
drier climate in which personal hygiene was overlooked
and disregarded and into venereal syphilis in those areas
where inhabitants exhibited a civilized society and paid
more attention to personal hygiene. The advocates of this
hypothesis consider as irrelevant the theory according to
which the 44 members of Christopher Columbus crew and
the 10 indigenes brought along to Europe could be
blamed for syphilis spreading in the whole Europe in just
a few years [10,11].
The Columbian hypothesis. This very popular
hypothesis states that the navigators in Columbus fleet
would have brought the affliction on their return form the
New World in 1493 [3,12]. This theory is supported by
documents belonging to Fernandez de Oviedo and Ruy
Diaz de Isla, two physicians with Spanish origins who
were present at the moment when Christopher Columbus
returned from America. The former, sent by King
Ferdinand of Spain in the New World, confirms that the
disease he had encountered for the first time in Europe
was familiar at that time to the indigenes who had already
developed elaborated treatment methods. As for Ruy Diaz
de Isla, the physician acknowledges syphilis as an
unknown disease, so far not seen and never described,
5
Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014
that had onset in Barcelona in 1493 and originated in
Espaola Island (Spanish: Isla Espaola), a part of the
Galpagos Islands. Ruy Diaz de Isla is also the one that
states in a manuscript that Pinzon de Palos, the pilot of
Columbus, and also other members of the crew already
suffered from syphilis on their return from the New World
[10,12].
Ever since, numerous opposites of the Columbian
hypothesis tried to prove the pre-existence of syphilis in
the Old World, by finding evidence consisting of specific
lesions on skeletal remains dated before Columbus
journey in America. Radiocarbon dating along with
several other modern means of dating, as well as more
careful examining of such remains proved that all skeletal
parts with specific luetic lesions dated not before, but after
1492. On the other hand, not all skeletal parts evoked by
the opposites of Columbian hypothesis were actually
exhibiting syphilis lesions. However, in 16 bone fragments
the syphilis diagnosis could be certified and modern
dating methods showed pre-Columbian origin. Harper et
al. explained in an article published in 2011 that all these
skeletons were located in coast areas from Europe, in
which sea food represented an important part of the
inhabitants diet. The sea food contained older carbon
from the bottom of the ocean that interferes with carbon
dating, therefore, after corrections and adequate
adjustments have been made, it could be proven that the
skeletons actually could not be dated before Columbus
return to Europe, as previously considered [13].
Unlike Europe, the American continent was able
to present clear evidences supporting the existence of
syphilis in pre-Columbian period. In this respect, skeletal
lesions characteristic for the diagnosis of syphilis which
has been identified in various areas plead for syphilis
existence in these areas before Columbus discovered
America. In addition, radiocarbon dating of the bone
fragments showed an age of several thousand years
[4,14].
Syphilis in Europe
In 1489, Pope Innocent VIII was in conflict with
Ferdinand I of Naples because the Italian King refused to
pay his debts to him. As such the Pope offered the
kingdom of Naples to Charles VIII who was the Affable of
France, and to a certain extent was entitled to reign over
this territory by his paternal grandmother, Mary of Anjou.
In 1494 Ferdinand I died and his successor, Alfonso II
announced his pretences to the Duchy of Milan, which
was controlled for a long time by Ludovic Sforza. Ludovic
Sforza, in order to avert the threat represented by Alfonso
II, encouraged Charles the VIII th to accept the proposal
made by Pope Innocent VIII and to conquer the kingdom
of Naples. At the end of 1494, one year after the return of
Columbus from his first expedition to America, Charles
VIII entered Italy with an army of 25.000 men, mainly
Flammand, Garcon, Swiss, Spanish and even Italian
mercenaries. Initially his army entered Rome, where, for
 Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014

one month, it led a life of limitless depravity. In February efforts, the disease later identified as syphilis entered the
1495 the army of Charles VIIIth entered Naples without city of Rome. Therefore, some of the chroniclers of the
encountering any resistance, as the Neapolitan army was time blamed the Jews for the spread of syphilis in Europe;
made out of no more than 1.000 Italian, German and according to them, the disease was already present on
Spanish mercenaries. The French army was well received Italian territory before Naples invasion by the French in
by the locals hoping for a better life under French 1495 [6,12,17,18].
occupation, but later on changed their opinion as they
witnessed great flourish in thefts, depravity and mess. Syphilis in artistic representations
The increasing power of Charles VIII leads to an alliance The oldest artistic representation of syphilis is
made by the Italian princes, including Ludovic Sforza, who considered one on a Peruvian jug dating back to VIth
defeats Charles VIII in the battle of Fornovo in July 1495. century, depicting a mother suffering from syphilis holding
It is during this battle that the Italian physicians described a child in her arms; the mother shows a saddle nose and
for the first time a disease they have seen on French superior incisive teeth with notches on their free margins.
soldiers bodies, manifested as a generalized eruption The piece belongs to a collection of jugs also
consisting of pustules, more terrifying than leprosy and encompassing two jugs illustrating leprosy and
elephantiasis and that could be lethal and was transmitted leishmaniasis [19].
through sexual intercourse. The disease proved to be Albrecht Drer, a German artist, depicts in
syphilis, and the French army was soon blamed for woodcuts, for the first time in Europe, in 1496, the image
spreading the affliction throughout Italy [12,15]. of a mercenary whose skin bears sores of multiple
Laura M. Gough, specialist in history of chancres (Figure 1). Next to the image lays written a text
medicine, notes that the war conditions represented a by physician Theodorus Ulsenius warning on the new
favorable field for the first outbreak of syphilis. It has disease, also describing its signs and symptoms,
occurred during Italian invasion by the French armies, in a mentioning that the illness is not curable and establishing
period of time when all great powers of Europe (France, a direct link between the epidemic and the grand
Spain, the Holy Roman Empire and the Papal States) astrological conjuction in 1484 [19,20].
wanted to gain control over the Apennine Peninsula. As
both French and Italian armies were made out of
mercenaries brought from the entire Europe, and as the
wars lasted for 30 years a sufficient interval not only for
marriages between mercenaries and local females, but
also for rape and prostitution-the disease has spread
rapidly across Europe as the mercenaries returned to
their homeland [15,16].
An important aspect to consider is also that
syphilis was, at the very beginning, a disease of great
severity, a more rapid spreading and atypical in its
evolution as compared to nowadays syphilis, the fatal
cases were not rare. The supporters of the Columbian
hypothesis advocate that the extreme severity if the
condition was mainly due to its novelty, as the population
had no time to gain any immunity against the ailment as
the venereal syphilis became endemic in Europe, certain
strains of T. pallidum have selected, and the disease
gained a milder course [17].
The spread of the syphilis across Europe was
frequently associated with the invasion of Naples by the
French army. However, ever since fewer popular theories
have been developed. In 1492 Ferdinand de Aragon and
Isabel of Castilla issued the Edict of Expulsion of the
Jews, stating that all the individuals of Hebrew origins
refusing to convert to Catholicism were to be expulsed
from Spain and the rest of its territories. On this occasion,
approximately 200.000 Jews have left the country for
Northern Africa and Southern Europe. On their way, a
part of them temporarily settled at the gates of Rome; Fig. 1 A mercenary whose skin presents multiple chancres,
they were not allowed in Rome, and in the new Diaspora woodcut by Albrecht Drer, 1496 published in a Romanian
an outbreak occurred, killing 30000 individuals. Despite all book in 1933 [21]

6

A work of Sebastian Brandt depicting Saint Mary
with the Child dates from the same year, 1496 (figure 2);
the Holy Child throws light spears to punish or cure the
sufferers of syphilis, represented as individuals with
multiples ulcers and sores. In another part of the woodcut
depiction, King Maximilian I and his Knights are ready to
receive the crown as reward for the edict he issued in
1495, stating that the disease was a consequence of
blasphemy and sins, punishing the suffers of syphilis for
their immoral behavior [15,19,22].
Fig. 2 Saint Mary and the Holy Child punishing the
sufferers of syphilis, woodcut, 1496 [21]
Another significant painting belongs to Jacques
Laniet, in the XVIIth century, an illustration of a man in a
fumigation stove, a fashionable method of treatment at
that time (Figure 3). On the barrel lays written pur un
plaisir, mil douleur (fr. correspondent of the phrase For a
pleasure, a thousand pains), a proverb very used in
those years. Another verbatim translation of this proverb
is for a night with Venus, a life with Mercury [23].
Fig. 3 Depiction of a man in a fumigation stove, engraving
by Jacques Laniet, Paris, 1659, as published in a
Romanian book in 1933 [21]
7
Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014
The allegory of syphilis, a work of Luca Giordano
depicting Venus and a young man with alopecia and
crusted papules on the scalp, as well as collapsed nose
bone, and Warning against syphilis painted by Johan
Sadeler presenting Venus giving birth to a contaminated
milk spring from her breasts and a shepherd -allusion to
Francastos poem on the origins of syphilis [23].
The autoportraits of Gerard de Lairesse (1641-1711), as
well as his portrait painted by Rembrandt in the XVIIth
century highlight in a clear manner the congenital syphilis
sequelae of the Dutch painter, amongst which, frontal
bossing and saddle nose [24].
Eduard Munch (1863-1944), an expressionist Norwegian
painter presents in The inheritance the image of a
young mother in tears holding a child with syphilis
stigmata in her arms. The painting was initially named
the syphilitic child. According to some critics, Munch was
ridiculing in his painting the iconic image of Madonna and
the child. Pablo Picasso (1881-1973) was also impressed
by this disease. His work The Wages of Sin is an
allegory of venereal diseases and presents a sailor
among prostitutes and a medical student holding a skull,
as the symbol of death. This work represents actually a
sketch of Les Demoiselles dAvignon (1907), in which the
artist gives up the male characters of the painting and
illustrates solely the women who are no longer feminine
and beautiful, but unattractive. Some critics believe that
this painting points out the artists fear of venereal disease
[25].
Famous historical figures diagnosed with or strongly
suspected of syphilis
The transmittance of sexual diseases has always been
associated with promiscuity and vulnerable population
groups [14]. However, the rapid spreading proved not to
avoid any geographical, racial or social barriers, affecting
also great personalities along the history.
The writers were among the most affected category which
was more likely, due to the promiscuous and bohemian
life, to have the disease. Alphonse Daudet, Thomas
Chatterton, Keats, James Boswell, Baudelaire, Heinrich
Heine, Dostoievski and Oscar Wild are only a few
examples of writers suffering from syphilis. Romanian
poet Mihai Eminescu was diagnosed with syphilis too. He
died in a mental institution at the age of 39 years [26-28].
Even the philosophers, who were usually considered
superior minds, insensitive to women charms, also have
suffered for syphilis. The most famous of them were
Friedrich Nietzsche (1844-1900) and Arthur
Schopehnauer (1788-1860). The last has contracted the
disease while still a student, and in time, developed a
tendency to misogyny [26].
Famous Casanova is widely and iconically known for his
excellent techniques of seduction. However, most of his
sexual partners were actually prostitutes, and this may be
the reason why he had gonorrhea four times, cancroids
for five times, syphilis and genital herpes [26,28].
It is also presumed that famous painters as Eduard
Manet, Paul Gauguin, Vincent van Gogh and Goya, as

well as composers like Ludwig van Beethoven, Robert
Schumann and Franz Schubert suffered for syphilis [26].
Furthermore, the monarchy was not spared of the
implacable disease. One example is Tsar Ivan IV
Vasilievici (known in history as Ivan the Terrible), Prince
of Moscow (1530-1584) who contacted syphilis after the
death of his wife. Some authors blame syphilis for his
brutal behavior [26,28,29]. King Henry III and Charles V
of France, Henry VIII and George IV of England, Paul I of
Russia and Maximilian I of Holy Roman Empire are other
examples.
Al Capone, the famous gangster who led a crime
syndicate in the times of Prohibition in the United States
supposedly died of neurosyphilis, as a consequence of
aggravation of its manifestation after his imprisonment in
Alcatraz [28,29].
The history behind the establishment of the etiology
of syphilis
From the very beginning numerous theories on the origin
of syphilis existed, most of which linking initially syphilis
and leprosy together. According to several fables of the
early XVI th century, syphilis was the result of a sexual
relation between a Spanish prostitute and a leper. The
prostitute also infected the soldiers of Charles VIII.
Paracelsus (1493-1541) considered that syphilis was the
result of a sexual intercourse between a prostitute
suffering from gonorrhea and a French leper. In
compliance to other theories of the time, the disease
might have been the outcome of the relationship of a
prostitute having a uterine abscess with a leper or the
result of poisoning the wine with blood coming from a
leper [6].
Sexual transmitted diseases were seen as a single
disease for many centuries. The differentiation between
gonorrhea, cancroids and syphilis as distinct maladies
was achieved no earlier than XIXth century. In the
beginning of XVIIIth century there were several doctors
who treated syphilis and gonorrhea as separate entities.
However, in 1767 John Hunter a famous physician of
venereal diseases at that time (1728-1793) conducted an
experiment consisting of an inoculation of the urethral
secretion of a gonorrhea patient in the prepuce of a
healthy patient, the last developing syphilis shortly
afterwards. Consequently, his experiment proved that
syphilis resulted from gonorrhea. What Hunter has missed
out was that the patient from whom the urethral secretion
was taken had both syphilis and gonorrhea. However his
experiment, widely acknowledged in his poque, delayed
the differential diagnosis of the two diseases with a few
decades [7,30].
In 1831 Ricord has designed a larger study on syphilis
and gonorrhoea and succeeded to show that the last
occurs only after contact with gonorrohea patients, whilst
the former only after contact with syphilis patients [7].
It was not earlier than 1905 that Schaudinn (1871-1906)
and Hoffman (1868 1959) have discovered the etiologic
agent of syphilis, whom they have named Spirochaeta
pallida, on various syhilis lesions, proving its existence in
both fresh and Giemsa coloured specimens. It was them
8
Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014
who changed the name of the bacterium subsequently to
Treponema pallidum [7,29,31].
In 1906 Landsteiner introduced the use of the dark-field
microscopy method for the detection of the spirochete of
syphilis. In 1910 the German bacteriologist August
Wasserman (1866-1925) came with the first serologic test
for syphilis and in 1949 Nelson and Mayer have
conceived Treponema pallidum immobilization test (TPI),
the first specific test for T. pallidum [29,32]. Their
discoveries had a very important role in detecting the
disease in patients who were suspected of syphilis, as
well as in other healthy individuals, and in monitoring
syphilis response to treatment.
Syphilis treatments along the history
Initially, the treatment of syphilis included less efficient
methods that were accompanied by pain and multiple
adverse reactions [29]. Taking into consideration that the
disease was associated with the discovery of the
American continent, numerous treatments included plants
brought from the New World, such as the guaiac tree (lat.
Guaiacum Officinale), known also as sasafras or willow
(Salix), which led to the widest recognition at the time
(Figure 4). These plants acted as purgative agents, lead
to sudoration, diarrhea and the increase in urinary debt
and were believed to be blood cleansers [7]. One of the
main supporters of the guaiac tree utilisation in the
treatment of syphilis, and in the same time an ardupus
opponent of mercury treatment, was Ulrich von Hutten
(1488-1523), a former priest who described in a detail the
manifestations of the disease as well the simptoms of
mercury intoxication, based on his own experience as a
sufferrer from the disease [15,33]. From the guaiac tree a
decoction was made, the resulted potion was boiled and
the patient was assumed to consume the mixture daily for
30 days. Before drinking the potion, the patient was
covered in blankets in order to induce perspiration, and a
mild purgative was also administered [15].
Fig. 4 Guaiacum officinale (guaiac tree), used widely for
the treatment of syphilis [21]
Paracelus (1493-1541) was one of the first
supporters of the mercury treatment. Mercury was used in
Arabic medicine in the treatment of several dermatomes
as well as leprosy, and succeeded to gain rapidly an
important place in medical field at that time. Mercury is a
potent diuretic that also leads to excessive salivation
when administered in toxic doses. At the time, is was
 Journal of Medicine and Life Vol. 7, Issue 1, January-March 2014

considered that the virus was eliminated from the body
through sweat, salivation and diuresis [15,33,34]. There
were several methods of administering mercury. Thus, in
a mixture with grease, mercury was administered
topically, leading to ulcerations. Barbarossa pill, named
after the Turk admiral who gave the pill to his soldiers and
was affected by the malady, contained a mixture of
mercury and perfume essence and fruit flavours [7].
Mercurous chloride (calomel, Hg2Cl2) was a white salt
able to be administered orally, topically or by injections.
The metallic form of mercury was administered also under
the form of therapeutic fumigation. Patients seemed to
find the adverse reactions of the treatment acceptable,
however, the treatment lead to systemic intoxication
(hidrargirism) and pneumonia [33].
Bismuth salts were introduced in syphilis
treatments in 1884. These compounds were less toxic
than mercury, in the same time bearing a stronger
bactericidal effect that the former, consequently,
becoming the cardinal heavy metal employed in syphilis
treatment [33].
German scientist Paul Ehrlich (1854-1915)
received Nobel Prize in Physiology and Medicine in 1908
for his discovery of arsphenamine (Salvarsan). The
scientist discovered the compound that acted like an
antibiotic by accident, while working on finding a cure for
Trypanosoma brucei. Ehrlichs desire was to discover a
magical bullet- a drug able to specifically bind to a
bacterium and kill it, without affecting human cells.
Salvarsan was also denominated as Compound 606, as
it was discovered after 606 failed experiments (Figure 5)
[7,35,36]. The safer novel drug that superseded the more
toxic and less water-soluble salvarsan as a treatment for
syphilis was Neosalvarsan, also an arsenic compound.
Both Salvarsand and Neosalvarsan were replaced in the
treatment of syphilis by Penicillin, after 1940.
Fig. 5 The laboratory
in which famous 606
compound was
invented [21]
Observing that fever lead to symptomatic
improvement of neurosyphilis, various methods of fever
induction have been experimented with turpentine,
tuberculine, mercury and even Salmonella typhi. In 1917,
the Austrian physician Julis Wagner-Jauregg (1857-1940)
includes malaria in the treatment of syphilis. Malaria
induced fever paroxysms able to be controlled, as quinine
had already been discovered. Jauregg injected patients
suffering from malaria with blood presenting Plasmodium
vivax. The patients exhibited fever paroxysms lasting for
approximately 6 hours and core temperature returning to
normal values; quinine was injected after 3-4 cycles on a
2 day period, in order to treat malaria. In 1927 Jauregg
received Nobel Prize for Physiology and Medicine for his
discovery [29,37].
In 1928, Alexander Fleming (1881-1955)
discovered penicilin and from 1943, it became the main
treatment of syphilis [7,29]. Nowadays, worldwide,
prevention and treatment programs control syphilis
spreading.
Conclusion
Treponema pallidum infection in men not only
provoked a disease that represented a threat to humans
for many centuries, but it also had a tumultuous history.
From examining it, one could learn how easy was to place
stigma not only on individuals affected by the disease, but
on entire nations, as countries were blamed along the
history for the spread of the disease. Throughout the
centuries, syphilis has affected individuals of various
origins, from monarchs, painters and philosophers to low
income people, mainly due to promiscuity. Various
treatments to cure the disease were tried along the
centuries; nowadays, penicillin and prevention programs
control the disease.

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