Syphilis, and why it is rising

In 1530 an Italian physician and poet, Girolamo Fracastoro, wrote a poem about a shepherd named Syphilus who insulted a god and was struck down with a hideous new disease as punishment. The disease took the shepherd's name. Before that it had no settled name, only nationalities: the English called it the French disease, the French called it the Neapolitan disease, the Poles blamed the Russians, and almost everyone blamed someone across the nearest border. It swept Europe from the 1490s and it terrified people, with good reason.

What it does, and why it earned its dread

Syphilis is called the great imitator because it moves in stages and disguises itself as other things. It begins with a single painless sore that heals on its own, so it is easily missed. Weeks later comes a rash, often on the palms and soles, plus flu-like illness, and that fades too. Then it can go silent for years while quietly doing harm. Left untreated it can reach the heart and the brain. In the pre-antibiotic era its late neurological form, general paralysis of the insane, was so common that in some asylums it filled up to half the beds in the men's wards, and those patients died, usually within a few years, of dementia and paralysis caused by an infection they had caught decades earlier. Its spinal form, tabes dorsalis, robbed people of coordination and sensation. It has been linked, rightly or in rumour, to a long roll of composers, writers and rulers; Al Capone spent his last years in documented mental decline from neurosyphilis. In pregnancy it still crosses to the baby, causing congenital syphilis, stillbirth and lifelong disability, which is one of the reasons every pregnant woman in the UK is offered a syphilis test.

The treatments people endured before penicillin were their own horror: mercury, so toxic and so useless that it spawned the rueful saying, a night with Venus, a lifetime with Mercury. Then in 1910 came Salvarsan, an arsenic compound hailed as the first magic bullet, still grim but a genuine step forward. Penicillin, from the 1940s, finally made it curable and turned general paralysis of the insane from a common death sentence into a medical rarity. The disease also produced one of medicine's great ethical crimes, the Tuskegee study, in which treatment was deliberately withheld from black American men for decades; a sober reminder of how badly this can be handled.

The modern point

Syphilis never left, and UK diagnoses have risen sharply in recent years. It is found by a blood test, detectable from around six to twelve weeks after exposure, so timing matters and a repeat is sometimes needed. Penicillin cures the infection at any stage, usually by injection, and here is the crucial catch: it kills the bacterium but it cannot undo damage already done. Once syphilis has scarred the heart valves or destroyed nerve tissue in the brain or spinal cord, curing the infection stops it getting worse but does not give back what was lost. That is why early matters so much. Treated in the first months it is a clean cure with nothing left behind; left for years, the cure can come too late to save the function.

The honest summary

Syphilis is an old killer that medicine tamed, not one that disappeared. It hides, it imitates, and it is rising again. A blood test finds it and penicillin cures it. The horror is entirely avoidable now, which is rather the point of testing.