Count on Syphilis
In Germany, more people are getting syphilis again. Women are also affected - and in some cases unborn children. But those infected are not always recognized, and while effective remedies exist, the right treatment is sometimes lacking.
Dismayed, London doctor Dr. Horace Selby, while reading the newspaper in the morning, made a note of an unfortunate accident: Late the evening before, his patient, Sir Francis Norton, fell under the wheels of a heavy horse-drawn carriage and died. Apparently, the young man, who wanted to get married soon, saw himself in a hopeless situation and ended his life himself. The reason for Norton's despair was the doctor's diagnosis the day before: Norton had contracted syphilis. However, in this sad short story, "The third generation," written by Arthur Conan Doyle in 1894, the name of the venereal disease is never directly pronounced.
Ivan the Terrible, Catherine the Great, Cardinal Richelieu, Gustave Flaubert, Franz Schubert, Paul Gauguin or Oscar Wilde – the list of patients is varied, but the diagnosis is the same for all: syphilis. Around 1500 it had triggered a Europe-wide epidemic, which is why it was assumed that it had been brought to Europe from Haiti in the course of the discovery of America. It quickly became clear that the "French disease" is mainly transmitted through sexual intercourse. More recent finds in Britain had unearthed even older victims - so were the Vikings to blame for the new scourge?
No Retreat…
Since the infected person goes through a series of stages with a wide variety of symptoms, there has always been something mysterious about syphilis. Only in the 20th century did the disease become more predictable and finally curable: in 1905 Fritz Schaudinn and Erich Hoffmann identified the spirally wound bacteria Treponema pallidum as the cause. Just one year later, August Wassermann developed an antibody test that could be used to reliably detect an infection with the syphilis pathogen even in people without symptoms. Thanks to the development of penicillin, syphilis patients have been treated successfully since 1943.
Although the number of syphilis rose again briefly after World War II, the disease in Germany declined sharply, especially from the late 1970s to the end of the 1990s (1978: over 9000 reported cases, 1993: around 1000 cases). As a welcome side effect, fewer and fewer women transmitted syphilis to their child during pregnancy.
The bacterial pathogens can be transferred to the fetus via the placenta from about the fifth month of pregnancy. Depending on the phase of the disease the pregnant woman is currently in, the result is stillbirth or miscarriage. Or the children are born with the characteristic symptoms of congenital syphilis ("syphilis connata"): underweight, withered and sagging skin, blister-shaped or papular skin changes, bloody cold and swelling of the liver and spleen.
Sometimes the disease only shows up through characteristic abnormalities when the children are already "Image" for a few years. Like Sir Francis Norton of Doyle's short story, who had barrel-shaped incisors, was hard of hearing, and suffered from corneal infections. The symptoms described by Doyle, who was himself a trained medical doctor, leave no doubt that Norton was infected in the womb [1]. alt="
… permanent
Rana Chakraborty, a specialist in pediatric infectious diseases at St George's Hospital in London, fears children are once again at risk from the life-threatening disease as syphilis spread in some sections of the UK population since 1996. "The defeated syphilis must be expected again"
(Stephan Lautenschlager) According to the British pediatrician, some doctors may overlook cases of congenital syphilis because they are no longer familiar with the symptoms of a once-common but now rare infectious disease.
Chakraborty presented the results of a study at a meeting of the British Federation of Infection Societies in early December. According to this, in the period from summer 2000 to summer 2003, indications of a syphilis infection were found in the blood of 70 of the 12,600 pregnant women in the course of check-ups.
Congenital syphilis in the child can be reliably prevented by appropriate treatment of the pregnant woman with an antibiotic. However, only eleven of the women, who were at high risk of transmitting the bacteria to the unborn child, received drug treatment for syphilis, in many cases inadequately and without the required repeated serological controls.
Although there are national guidelines on how syphilis should be treated correctly in pregnant women, according to Chakraborty, these are only observed in the rarest of cases. However, this increases the risk of a life-threatening illness in the children.
Stephan Lautenschlager, specialist in skin and venereal diseases at the Triemli City Hospital in Zurich, confirms: "The syphilis we thought had been defeated has to be reckoned with again." In 1999, the World He alth Organization reported 280,000 new infections with Treponema pallidum in Russia, and high numbers of cases were also reported from other Eastern European countries.
In Germany, too, more syphilis patients were registered again. "Since 2000 we have observed a significant increase in syphilis cases," says Osamah Hamouda from the Robert Koch Institute in Berlin. This year the numbers would be at the same level as last year – a total of 3210 cases were reported to the Robert Koch Institute in 2005; The infection epidemiologist explains [2]., although there are federal states in which the numbers have continued to rise and other regions with significant declines.
Risky Practices
Eighty percent of syphilis sufferers are male, mostly homosexual. "Heterosexual men are less often affected, but syphilis has also increased among them," says Hamouda. "Since the year 2000 we have observed a significant increase in syphilis cases"
(Osamah Hamouda) He sees the reason for the rise in numbers, especially among homosexuals, in the changed perception of the HIV risks: "Hazardous sexual practices are being chosen again, partners are changing more often and the use of condoms is neglected."
Lautenschlager also sees it this way: "Twenty years of 'safer sex' in the HIV era has led to a certain tiredness with condoms." According to the Swiss doctor, unprotected oral sex is also responsible for the increase in syphilis. While it is very unlikely that HIV would be transmitted in this way, that is to be expected for the syphilis pathogen.
The syphilis outbreak in the greater Aachen area shows that not only homosexual men but also women and thus children during pregnancy are potentially at risk. In 2005 alone, 45 women and 55 men fell ill [3]. Prostitution contacts and procurement prostitution are apparently responsible for the spread among heterosexual men and women.
In the national average, however, syphilis is rare in women; children with congenital syphilis are isolated cases. "In the current year and in 2005, four cases were reported of infected mothers infecting their child. In 2004 there were seven children," says Hamouda.
Vigilant precaution needed
How can congenital syphilis even occur despite prenatal care? Preventive medical check-ups that were delayed or not performed at all, a misinterpretation of laboratory results or diagnostic errors were the reasons for the 14 cases of congenital syphilis that were serologically confirmed between 1997 and 2001 in the Enders testing laboratory in Stuttgart [4]. "Frauenärzte, pediatricians and obstetricians need to be reminded that syphilis exists"
(Osamah Hamouda) All mothers of the 14 children were clinically normal, eleven had a positive syphilis screening test, but only two of these women had been treated with antibiotics at all.
"Gynecologists, pediatricians and obstetricians need to be reminded that syphilis exists," says Osamah Hamouda. Not everyone is affected by the increase in syphilis cases. But with a corresponding lifestyle and anamnesis, gynecologists should think about syphilis. In addition to the test, which is routinely carried out at the beginning of a pregnancy, it is also necessary to follow up during the nine months, especially in risk groups, because - as the Berlin epidemiologist warns - "a woman can still be infected during pregnancy".
