From mercury to malaria to penicillin: The history of the treatment of syphilis at the Mayo Clinic—1916–1955

Sartin, Jeffrey S.; Perry, Harold O.

doi:10.1016/0190-9622(95)90136-1

Cited by 30 publications

(24 citation statements)

References 7 publications

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“…Kosters et al suggested that early aortic involvement might occur more often than thought, which is supported by the findings in our study. In addition, neurosyphilis infection can occur during any stage of syphilis4; however, on PET scan in our case series, we did not find any evidence of inflammation in the central nervous system. Neuroinflammation may be difficult to detect, however, on PET scanning due to physiologic cerebral metabolic activity.…”

Section: Discussioncontrasting

confidence: 80%

“…Involvement of the aortic root is the most common manifestation of cardiovascular syphilis. In 1926, in his seminal work on the natural history of syphilis, Stokes reported on 200 cases of syphilis and aortic disease 4. Similar reports of aortitis and syphilis were described again in 1942 5.…”

Section: Introductionmentioning

confidence: 82%

“…Since all participants were treated, we do not know whether or not or how long the aortic inflammation would resolve without treatment. Other complications of early syphilis due to dissemination such as ocular syphilis and neurosyphilis are devastating but are uncommon (<2%) 4. Clinicians should be aware that early dissemination of syphilis occurs with some frequency though some manifestations may indeed be transient and resolve with treatment.…”

Section: Discussionmentioning

confidence: 99%

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Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis

Davey¹,

Kojima

Konda³

et al. 2017

Sex Transm Infect

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Objectives Syphilis infection persists globally contributing to preventable and treatable morbidity and mortality. How extensive early syphilis disseminates is unknown. To better understand the relationship between early syphilis infection and inflammation over time, our study enrolled six individuals recently infected with syphilis for sequential positron emission tomography (PET) scans. Methods We evaluated a case series of six individuals with high syphilis titres (two secondary, two early latent and two latent, unknown duration, but with high titre) who received sequential PET scans to assess inflammation over time and its response to treatment. Results At time of PET scan, four of the six individuals were co-infected with HIV. One of the four was not on antiretroviral therapy and three of the four were not virally suppressed (viral load of >400 copies/mL). Baseline rapid plasma reagin (RPR) titres ranged from 1:64 to 1:256 (four of the six participants had prior non-reactive RPR results). Five of the six participants had mild to intense hypermetabolic PET scan activity consistent with cervical (n=5), axillary (n=4), inguinal (n=5) and retroperitoneal (n=1) adenopathy. Mild hypermetabolic activity in the thoracic aortic wall, suggesting aortitis, was present among the same five participants and resolved within 30 days for four of the five participants and 60 days for the other participant. However, widespread lymphadenopathy remained present in PET scans up to 3 months following treatment in two participants. We did not find any abnormal PET scan activity of the central nervous system. Conclusion We found abnormal aortic wall PET scan activity suggesting aortitis to be common in a case series of patients with early syphilis. In research settings, PET scans may be a sensitive tool to monitor inflammation associated with syphilis.

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Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis

Davey¹,

Kojima

Konda³

et al. 2017

Sex Transm Infect

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“…It is very difficult to compare (or even interpret) the results of the many studies evaluating malarial therapy (e.g., [2][3][4][5][6]) because of differing terminology, subjectivity and reporting time frames. Sartin and Perry [7] stated, "The lack of placebotreated control subjects and the rigidly predefined criteria for therapeutic end points prohibits a true assessment of therapeutic efficacy in the modern sense ( [8]), but it is clear that syphilologists of the time considered the treatment a breakthrough. "…”

Section: Introductionmentioning

confidence: 99%

Treatment and diagnostic accuracy of neurosyphilis at Boston City Hospital's Neurological Unit, 1930–1979

Patterson

Vilensky

Robertson

et al. 2012

Journal of the Neurological Sciences

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“…The publication on the treatment of four syphilitic patients with penicillin by Mahoney et al was soon quickly followed by a case report of the successful resolution of tertiary cutaneous syphilis with penicillin [4]. While the earliest trials of penicillin often failed in hindsight due to incorrect dosing or impurities, the burgeoning success of penicillin in treating tertiary syphilis originally with 320,000 U of penicillin over an 8 day time period lent credence that the cure to syphilis would lay in the newfound drug [5]. Old treatments quickly died out and penicillin abruptly became the mainstay.…”

mentioning

confidence: 99%

Penicillin: The Old/New Wonder Drug

Allen¹,

Hossain²,

Abidi³

et al. 2017

Adv Tech Biol Med

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Penicillin (PCN) has been shown to treat psoriasis effectively and be curative in many cases. Streptococcus is the organism responsible for beginning the process and has previously escaped detection by moving intracellularly or by forming biofilms. The treatment is low dose for many months and thus is similar to rheumatic fever. Arthritis has been shown to be caused by biofilm-forming dental and Lyme spirochetes, and these organisms, like the streptococcus in psoriasis, have escaped detection. Penicillin, plus a biofilm-dispersing agent is effective in treating arthritis in which tissue destruction has not already occurred.Alzheimer's disease has been shown to be caused by those same spirochetes involved in arthritis, and, is in every way, similar to the dementia of neurosyphilis caused by Treponema pallidum. These organisms make biofilms that induce B amyloid and a Toll-like receptor 2 response leading to tissue destruction. Penicillin given prior to the organisms arrival in the brain (or before they create biofilms) would effectively prevent dementia in Alzheimer's as it does in syphilis. We have shown that biofilm-forming staphylococci are integral to the etiology of atopic dermatitis. Along with standard corticosteroid therapy, antibacterial treatment, as opposed to antibiotics, appears to be a better treatment in AD because all the organisms are multi-drug resistant and 60% are MRSA or MSRE. Treatment with PCN in psoriasis, arthritis, and syphilis, has thus far not led to resistance and may actually prevent resistance by killing organisms before they make biofilms and share resistance genes. rash [11]. The cutaneous manifestation typically accompanies the pharyngeal infection with the rash emerging due to erythrogenic toxins produced by the bacterium [10]. Treatment remains a ten-day course of oral penicillin VK or erythromycin, or a single intramuscular injection of penicillin G benzathine. If administered within 1 week of onset of acute pharyngitis, acute renal failure may be prevented [12]. Rheumatic feverLikewise, penicillin has equally revolutionized the treatment of rheumatic fever and the subsequent cardiac complications. Acute rheumatic fever occurs 2-3 weeks following infection of the pharynx by Group A streptococcus (GAS) [13]. Manifestations of acute rheumatic fever include arthritis, chorea, erythema marginatum and most importantly, carditis. Reinfection by GAS notably leads to valvular destruction and eventual heart failure [14]. While the reason exactly why infection by GAS causes rheumatic fever has yet to be determined, current hypotheses stipulate a relationship between the M protein of the bacterium, biofilm formation, and molecular mimicry between antibodies against bacterial proteins and cardiac membranes. Work by Catanzaro et al. noted that the development of rheumatic fever required living streptococci throughout the convalescent period, making penicillin treatment and prophylaxis essential [15].Treatment of acute rheumatic fever involves penicillin in alternate roles. Preventi...

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From mercury to malaria to penicillin: The history of the treatment of syphilis at the Mayo Clinic—1916–1955

Cited by 30 publications

References 7 publications

Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis

Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis

Treatment and diagnostic accuracy of neurosyphilis at Boston City Hospital's Neurological Unit, 1930–1979

Penicillin: The Old/New Wonder Drug

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