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Goodbye

Goodbye. ….and thanks for the syphilis! Robert Palmer Lead Advisor/Sp.Psych Guy’s and St. Thomas’ Hospitals. “He who knows syphilis, knows medicine”. William Osler. Syphilis backstory. The Columbian exchange theory

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Goodbye

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  1. Goodbye ….and thanks for the syphilis! Robert Palmer Lead Advisor/Sp.Psych Guy’s and St. Thomas’ Hospitals

  2. “He who knows syphilis, knows medicine”. William Osler

  3. Syphilis backstory • The Columbian exchange theory • Returned to Europe from the New World by Columbus and his randy crew. Linked by evidence of an outbreak in Naples in 1494

  4. Syphilis backstory • Pre-Columbian theory • Present in Europe before discovery of Americas • Suspected outbreak in a Friary in 13/14th C in Kingston upon Hull • Combination theory • No country nor race can be blamed, possibly in both Americas and Europe, • With Pinta and Yaws as weaker versions

  5. Syphilis backstory • Has ravaged the world through the centuries • Alleged syphilitics include: • Mussolini • Hitler • Charles VIII • Tolstoy • Lenin • James Hardy

  6. Syphilis backstory • More virulent version than known today during 14/15th centuries: • "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months”. (Diamond 1997)

  7. Syphilis backstory • Tuskagee syphilis experiment • Clinical study between 1932 and 1972 • 399 African American sharecroppers recruited with syphilis to follow the natural course of infection without treatment • When the study started treatment was often dangerous and unreliable • When penicillin became widely available scientists withheld treatment and information and participants were not allowed to access local treatment centres.

  8. Syphilis backstory • Tuskagee syphilis experiment • Ethically corrupt • Offered ‘special treatment’ - actually a lumbar puncture • At the end of the study in 1972 only 74 participants were still alive • 28 had died of syphilis • 100 died of related complications • 40 wives were infected • 19 children born with congenital syphilis • Formal apology from Clinton in 1997

  9. Syphilis backstory • Treatments: • Mercury: “A night in the arms of Venus leads to a lifetime on Mercury” Injected, ingested, rubbed on skin, fumigation • Malaria - by producing high fevers • Arsenic • Finally, penicillin

  10. Numbers of diagnoses of syphilis (primary, secondary and early latent) by sex, GUM clinics, England and Wales, and Scotland*: 1931 - 2006

  11. Rates of diagnoses of infectious syphilis (primary & secondary) by sex and age group, GUM clinics, United Kingdom: 1997 - 2006 Males Females Routine GUM clinic returns

  12. Diagnoses of infectious syphilis (primary, secondary and early latent) by sex and sexual orientation, London enhanced syphilis surveillance: April 2001 - December 2006 London Enhanced Syphilis Surveillance

  13. Syphilis today • Most cases among MSM • Attending with primary chancre • Secondary symptoms • Contact of • 96% self refer • 4% GP or other departments: dermatology, oncology and dentistry

  14. Syphilis today • Missing syphilis within primary care, considering chancre to be oral or anal herpes

  15. Syphilis today • This tertiary syphilis was considered to a be a breast cancer

  16. Syphilis today • Secondary syphilis often mistaken for a dermatological problem.

  17. Issues of importance for HA’s • Need for more in-depth contact tracing • Use of social networking and dating sites to trace partners • More involvement in the local public sex environments, using syphilis POCT • Need to follow up our patients and make sure they attend for repeat bloods • Not to give in when faced with large number of contacts

  18. Issues of importance for HA’s • To complete our contact tracing at follow up/RPR bloods • To be aware of the real possibility of reinfection • Importance of testing our HIV + MSM patients regularly (every three months) • Introduction of Determine Syphilis POCT

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