History of syphilis

The history of syphilis has been well studied, but the exact origin of the disease is unknown. There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew of Christopher Columbus as a byproduct of the Columbian exchange, while the other proposes that syphilis previously existed in Europe but went unrecognized. These are referred to as the "Columbian" and "pre-Columbian" hypotheses.

The first written records of an outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as "French disease", and it was not until 1530 that the term "syphilis" was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. The first effective treatment (Salvarsan) was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich which was followed by the introduction of penicillin in 1943. Many famous historical figures including Franz Schubert and Édouard Manet are believed to have had the disease.

The exact origin of syphilis is unknown. Two primary theories have been proposed, with variations on each. There is strong evidence to support that syphilis was present among the indigenous peoples of the Americas before Europeans traveled to and from the New World. However, whether strains of syphilis were present in the entire world for millennia, or if the disease was confined to the Americas in the pre-Columbian era, has been and continues to be debated.

The theory holds that syphilis was a New World disease brought back by Columbus and Martín Alonso Pinzón as an unintentional part of the Columbian Exchange. Columbus's voyages to the Americas occurred three years before the Naples syphilis outbreak of 1495. 538 skeletal remains in the Dominican Republic have shown evidence characteristic of treponemal disease in 6-14% of the afflicted population, which BM Rothschild et al. have postulated was syphilis. A more recent, modified version of the Columbian theory that better fit skeletal evidence from the New World, and also "absolved the New World of being the birthplace of syphilis", proposes that a nonvenereal form of treponemal disease, without the lesions common to congenital syphilis, was brought back to Europe by Columbus and his crew. Upon arrival in the Old World, the bacterium, which was similar to modern day yaws, responded to new selective pressures with the eventual birth of the subspecies of sexually transmitted syphilis. This theory is supported by genetic studies of venereal syphilis and related bacteria, which found a disease intermediate between yaws and syphilis in Guyana, South America. However, the study has been criticized in part because some of its conclusions were based on a tiny number of sequence differences between the Guyana strains and other treponemes whose sequences were examined. The 2011 Yearbook of Physical Anthropology published an appraisal by Harper, Kristin N., et al., of previous studies and stated that the "skeletal data bolsters the case that syphilis did not exist in Europe before Columbus set sail." The scientific evidence as determined by a systematic review of 54 previously published, peer-reviewed instances lends support to the theory that syphilis was unknown in Europe until Columbus returned from the Americas. According to this appraisal, "Skeletal evidence that reputedly showed signs of syphilis in Europe and other parts of the Old World before Christopher Columbus made his voyage in 1492 does not hold up when subjected to standardized analyses for diagnosis and dating, according to an appraisal in the current Yearbook of Physical Anthropology. This is the first time that all 54 previously published cases have been evaluated systematically, and bolsters the case that syphilis came from the New World." In an article criticizing the presentation of new research findings in PBS and BBC documentaries about syphilis, researchers said they showed "a blatant disregard for the peer review process in making the case for pre-Columbian syphilis in the Old World. [...] As in all scientific fields, in order to resolve the controversy over the origin and antiquity of syphilis in the Old World, there is a strong need for adherence to standard practice in scientific publication and the increased publication of relevant evidence in peer-reviewed journals."

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