Disruption of the dorsal roots leads to loss of pain and temperature sensation and areflexia. Geneva: 2001. "[17] However, Crosby considers it more likely that a highly contagious ancestral species of the bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. Among patients diagnosed with tertiary syphilis, the prognosis is less sanguine. Bai ZG, Yang KH, Liu YL, Tian JH, Ma B, Mi DH, et al. Clinical presentation is often asymptomatic, but can manifest in a number of ways. Prevention of viral sexually transmitted infections--foreskin at the forefront. Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of AmericaDisclosure: Nothing to disclose. It alters the appearance of bones in a highly specific manner, which one can find if one knows how to look [20, 21]. MMWR Recomm Rep. 2010 Dec 17. Fluids exuding from these lesions are highly infectious. [Medline]. [citation needed], As the disease became better understood, more effective treatments were found. Hagdrup HK, Lange Wantzin G, Secher L, Rosdahl VT. Department of Health and Human Services. However, when it does happen it can affect many different organ systems. Journal Article, You are being redirected to
[1] These are referred to as the "Columbian" and "pre-Columbian" hypotheses.[1]. HARRISON LW. Download 375 Syphilis Stock Illustrations, Vectors & Clipart for FREE or amazingly low rates! As Jared Diamond describes it, "[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." 19(4):217-21. Chancres occur mainly on the external genitals, vagina, anus, or in the rectum but can also occur on the lips and in the mouth. Early prediction of syphilis is therefore of great importance for heath planning and management. Most often, the lesions are macular, discrete, reddish brown, and 5 mm or smaller in diameter; however, they can be pustular, annular, or scaling. [Medline]. Goal: To evaluate the feasibility, acceptability, and yield of mobile community-based STD screening and treatment services in high STD incidence areas. The antibodies to the syphilis-causing bacteria remain in your body for years, so the test can be used to determine a current or past infection. Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions. 360(13):1349-51. The past decade has seen a sharp rise in syphilis cases among men, driven mostly by the MSM community. He also postulated that the disease was previously unknown, and came from the island of Hispaniola (modern Dominican Republic and Haiti). Serological response. The 3 general categories of tertiary syphilis are gummatous syphilis (also called late benign), cardiovascular syphilis, and neurosyphilis. Widespread mucocutaneous lesions are observed over the entire body and may involve the palms, soles, and oral mucosae. 1906-Another team of German researchers developed the Wassermann test, which is the main test used today to test for syphilis. [Medline]. "[14] Lobdell and Owsley wrote that a European writer who recorded an outbreak of "lepra" in 1303 was "clearly describing syphilis. Syphilitic meningitis is an early manifestation, usually occurring within 6 months of the primary infection. [MILLER JL, SLATKIN MH, BRODEY M, WECHSLER HL, HILL JH. [15] In 2020 DNA analysis of nine infected skeletons was advanced to defend the "pre-Columbian" hypotheses, but is short of conclusive. 2012 Dec. 39 (12):954-8. Crosby writes, "It is not impossible that the organisms causing treponematosis arrived from America in the 1490s ... and evolved into both venereal and non-venereal syphilis and yaws. Syphilis. [Full Text]. It has been shown that a higher proportion of infants are affected if the mother has untreated secondary syphilis, compared to untreated early latent syphilis. [...] 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. Used with permission from Wisdom A. Tabes dorsalis and general paresis may develop as in adults, with 8th cranial nerve deafness and optic nerve atrophy as well as a variety of other ophthalmologic involvement leading to blindness being additional features. During the first 5-10 years after the onset of untreated primary infection, the disease principally involves the meninges and blood vessels, resulting in meningovascular neurosyphilis. 1980 Jun 27. Histologically, the chancre is characterized by mononuclear leukocytic infiltration, macrophages, and lymphocytes. Sexually Transmitted Disease Surveillance 2007 Supplement, Syphilis Surveillance Report. 1–3 Additionally, historical data demonstrate that untreated syphilis in pregnant women, if acquired during the four years … http://www.cdc.gov/std/tg2015/pen-allergy.htm, http://www.cdc.gov/std/stats/trends2006.htm#syphilistrends, International Immunocompromised Host Society, Southern Society for Clinical Investigation, American College of Occupational and Environmental Medicine, American Society of Tropical Medicine and Hygiene, Southern Oncology Association of Practices, American Association for Physician Leadership, United States and Canadian Academy of Pathology, Emergency Medicine Residents' Association. Centers for Disease Control and Prevention: Centers for Disease Control and Prevention (CDC). [21] The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease. [Full Text]. Background: This cluster randomized trial was performed to test whether one-stop service could better prevent congenital syphilis than the conventional antenatal screening service in Mongolia. For patients who are pregnant and have early syphilis, it is likely that the mother will deliver a child not infected by syphilis (assuming the mother was treated appropriately). Early syphilis affects approximately 50 people per 100,000 in the United States and Western Europe but 200 to 500 people per 100,000 in Africa and Latin America. 201(11):1729-35. [34], Mercury was a common, long-standing treatment for syphilis, and its use as such has been suggested to date back to The Canon of Medicine (1025) by the Persian physician Ibn Sina (Avicenna);[35] although this is only possible if syphilis existed in the Old World prior to Columbus (see § Origin). In addition, patients with HIV are at greater risk for development or relapse of early symptomatic neurosyphilis for up to 2 years after treatment with intramuscular or intravenous penicillin. Background. [Full Text]. JAMA. 1986. All patients diagnosed with an STD should be screened for HIV infection. … Unprotected sex is the major risk factor for the acquisition of syphilis, especially among men who have sex with men (MSM), who accounted for 83.7% of all syphilis cases in the United States. MMWR Morb Mortal Wkly Rep. 2004 Mar 12. Syphilis has a myriad of presentations and can mimic many other infections and immune-mediated processes in advanced stages. In this stage, the spirochete can be isolated from the surface of the ulceration or the overlying exudate of the chancre. 1998 Oct. 16(4):687-90, x. 150,026,167 stock photos online. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", and the Turks called it the "Christian disease" or "Frank (Western European) disease" (frengi). Gummas usually disappear after … 150(10):705-9. Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Medical Association, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Most people with untreated syphilis do not develop tertiary syphilis. First described as the Great Pox, its true historical origins are unclear. Such defects marked the person as a social pariah, and a symbol of sexual deviancy. Fitzgerald TJ. The actual designation “syphilis” originates in an ancient myth about a shepherd named Syphilis . In 2008, an estimated 1.4 million pregnant women had active syphilis. Year Book Medical Publishers Inc; 1989. Lues TP stain. 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. [2], The history of syphilis has been well studied, but the exact origin of the disease remains unknown. [Medline]. Golden MR, Wasserheit JN. This city's maritime history, … [36] Giorgio Sommariva of Verona is recorded to have used mercury to treat syphilis in 1496, and is often recognized as the first physician to have done so, although he may not have been a physician. 60(3):1076-83. Syphilis is caused by the bacteria. microscopic view of syphillis. If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary. Since the discovery of penicillin in the mid-20th century, the spread of this once very common disease has been largely controlled, but efforts to eradicate the disease entirely have been unsuccessful. 53(9):197-8. [4], The incidence of congenital syphilis has increased to 11.6 cases per 100,000 live births in 2014, the highest congenital syphilis rate reported since 2001. In spite of provoking a strong humoral and cell-mediated immune response, T. pallidum is able to survive in the huma… According to Infectious Disease Physicians, 2002
[2] The first effective treatment, Salvarsan, was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich. BERTRAM FP. [2], Many well-known figures, including Scott Joplin, Franz Schubert, Friedrich Nietzsche, Al Capone, and Édouard Manet are believed to have contracted the disease. Lues hematoxylin and eosin stain. However, these claims have not been submitted for peer review, and the evidence that has been made available to other scientists is weak. [Medline]. Syphilis is a type of sexually transmitted disease (STD) that, if left untreated, can seriously affect your health. That the artist chose to include this image in a series of works celebrating the New World indicates how important a treatment, however ineffective, for syphilis was to the European elite at that time. European Journal of Clinical Microbiology & Infectious Diseases, "First European Exposure to Syphilis: The Dominican Republic at the Time of Columbian Contact", "The origin and antiquity of syphilis revisited: An Appraisal of Old World pre-Columbian evidence for treponemal infection", ”Skeletons point to Columbus voyage for syphilis origins”, "The Science Behind Pre-Columbian Evidence of Syphilis in Europe: Research by Documentary", "Introduction of Syphilis from the New World", http://www.sundaytimes.lk/101219/Timestwo/t2_01.html, "Medieval DNA suggests Columbus didn't trigger syphilis epidemic in Europe", "On the Origin of the Treponematoses: A Phylogenetic Approach", "Molecular studies in Treponema pallidum evolution: toward clarity? [1][2] 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. [4], In the United States, syphilis is more prevalent among persons of minority race and ethnicity. [39], Guaiacum was a popular treatment in the sixteenth century and was strongly advocated by Ulrich von Hutten and others. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. [14] From this centre, the disease swept across Europe. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. Some researchers argue that syphilis was carried from the New World to Europe after Columbus' voyages, while others argue the disease has a much longer history in Europe. Semin Fetal Neonatal Med. [Medline]. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks. These disparities were similar to disparities observed in 2005 and represent an increase in syphilis rates in all racial groups. Congenital syphilis (syphilis that is passed on from a woman infected with the disease to her unborn baby) is a major preventable public health problem. SYPHILIS B Y: A L I H A S S A N ? Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. 969023-overview
All MSM who test positive for syphilis should be considered at risk for HIV if not already infected and should be targeted for intensive HIV prevention interventions with pre-exposure prophylaxis (PrEP). Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center Later manifestations of congenital syphilis include bone and teeth deformities, such as “saddle nose” (due to destruction of the nasal septum), “saber shins” (due to inflammation and bowing of the tibia), “Clutton’s joints” (due to inflammation of the knee joints), “Hutchinson’s teeth” (in which the upper incisors are widely spaced and notched), and “mulberry molars” (in which the molars have too many cusps). While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, associating Treponema pallidum with neurosyphilis. The most significant and preventable of these include HIV, syphilis, and rubella. [Medline]. Ann Intern Med. THE TUSKEGEE STUDY OF UNTREATED SYPHILIS; THE 30TH YEAR OF OBSERVATION. Posterior column impairment results in impaired vibration and proprioceptive sensation, leading to a wide-based gait. It will benoticed that at the time ofsurvey morethan half the patients were over 21 years of age (Table Il). Cox DL, Chang P, McDowall AW, Radolf JD. [Medline]. for: Medscape. [12, 13]. In 1972, Buxtun went to the mainstream press, causing a public outcry. Background: Sexually transmitted infections, such as HIV and syphilis, are one of the major health care problems worldwide, especially in low- and middle … Of these, wet mucous patches are the most contagious. The Argyll-Robertson pupil, a pupil that does not react to light but does constrict during accommodation, may be seen in tabes dorsalis and general paresis. Note: If the case study does not suit your location or your choice, please kindly … An estimated 6 million new infections occurred worldwide in 2016. Sexually transmitted diseases treatment guidelines, 2006. Year Book Medical Publishers Inc; 1989. Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. Syphilis is a sexually transmitted bacterial infection. Patients who abuse IV drugs should be advised to avoid sharing needles and to use clean needles. [citation needed] However, the name is misleading, as smallpox was a far more deadly disease. Destructive bone disease in early syphilis. is a contagious bacterial infection that is transmitted through contact with an chancre on an infected person, usually during intimate sexual contact The Flemish artist Stradanus designed a print of a wealthy man receiving treatment for syphilis with the tropical wood guaiacum sometime around 1580. The precise location of the lesion causing this phenomenon is unknown. Cutis. Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. This worm-like, spiral-shaped organism infects people by burrowing into the moist mucous membranes of the mouth or genitals. Adolf Hitler (German: [ˈadɔlf ˈhɪtlɐ] (); 20 April 1889 – 30 April 1945) was an Austrian-born German politician who was the dictator of Germany from 1933 to 1945. [32] The ulcers suffered by British soldiers in Portugal were termed "The Black Lion". For example, host humoral and cellular immune responses may prevent the formation of a primary lesion on subsequent infections with T pallidum, but they are insufficient to clear the organism. During this stage, the spirochetes multiply and spread throughout the body. Since T pallidum does not invade the placental tissue or the fetus until the fifth month of gestation, syphilis causes late abortion, stillbirth, or death soon after delivery in more than 40% of untreated maternal infections. Celebrated on February 14, Valentine is venerated as the patron saint of lovers, epileptics, and beekeepers. Some scholars during the 18th and 19th centuries believed that the symptoms of syphilis in its tertiary form were described by Hippocrates in Classical Greece. Tuskegee syphilis study, American medical research project that earned notoriety for its unethical experimentation on African American patients in the rural South. Most new cases occur in men and women aged 20-29 years. Columbus's first voyages to the Americas occurred three years before the Naples syphilis outbreak of 1495. T. pallidum can also be transmitted by blood transfusion. [9] 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. This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time. It can be either acquired or congenital. The image below depicts the characteristic chancre observed in primary syphilis. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. [Medline]. Fourth, the risk behaviors associated with acquiring syphilis also increase the likelihood of acquiring HIV. Kupka R, Kassaye T, Saathoff E, Hertzmark E, Msamanga GI, Fawzi WW. Clin Infect Dis. Syphilis can be diagnosed by testing samples of: 1. Syphilis screening in people of refugee background. Primary syphilis results in ulcer which appears about 2-3 weeks after having sex with infected partner. Late cutaneous syphilis. Die Syphilis ist eine Systemerkrankung und verläuft in verschiedenen Stadien. [4], Syphilis acquisition increases the risk of HIV acquisition by 2- to 5-fold and makes transmission of HIV more efficient via various methods. The treponemes readily cross the placental barrier and infect the fetus, causing a high rate of spontaneous abortion and stillbirth. STIs have a profound impact on sexual and reproductive health worldwide.More than 1 million STIs are acquired every day. The cause of syphilis is infection with the spirochete T pallidum.T pallidum is solely a human pathogen and does not naturally occur in other species. Color Atlas of Sexually Transmitted Diseases. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. - ? The most common manifestation is aneurysm formation in the ascending aorta, caused by chronic inflammatory destruction of the vasa vasorum, the penetrating vessels that nourish the walls of large arteries. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. Mortality rates in general are greater among those affected, and late complications appear to occur more commonly in men than in women. In contrast, syphilitic gummas typically resolve promptly with high-dose penicillin. Thousands of new, high-quality pictures added every day. Among women, the reported primary and secondary syphilis rate increased from 0.9 to 1.5 per 100,000 population per year during 2005- 2008 and decreased to 0.9 in 2013. The morbidity of syphilis ranges from the relatively minor symptoms of the primary stages of infection to the more significant constitutional systemic symptoms of secondary syphilis and the significant neurological and cardiovascular consequences of tertiary disease. Sex Transm Dis. Within the first 2 years of life, symptoms are similar to severe adult secondary syphilis with widespread condylomata lata and rash. Methods: Out of 14 antenatal clinics in 6 districts of Ulaanbaatar, 7 were randomly selected for the one-stop service and the remaining for the conventional service. Cooley LA1, Pearl ML, Flynn C, Ross C, Hart-Cooper G, Elmore K, et al. Eur J Clin Microbiol. Azithromycin vs. benzathine penicillin G for early syphilis: a meta-analysis of randomized clinical trials. Fortunately, it can be treated and cured. This disease begins as just a painless sore on the genitals, mouth or some other part of the body. Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. Diseases & Conditions, 2003
Go to Pediatric Syphilis for complete information on this topic. Treponema palladium is the causative factor of syphilis. Young H. Syphilis. [54][55] Poet Sebastian Brandt in 1496 wrote a poem titled De pestilentiali Scorra sive mala de Franzos which explains the spread of the disease across the European continent. Cerebrospinal fluid. Primary and secondary syphilis--United States, 2005-2013. In Scotland, syphilis was referred to as the Grandgore or Spanyie Pockis. In the United States, syphilis testing is recommended for all refugees over 15 years AND refugees <15 years who are sexually active or have a history of sexual abuse or with a mother who tests positive for syphilis. [Medline]. Since latent syphilis can persist for years or decades, the manifestations of tertiary syphilis often occur much later in life, causing significant morbidity and even death if not identified and treated. These data indicate that approximately one third of patients left untreated will develop late complications, with 10% of the total developing cardiovascular syphilis; 6%, neurosyphilis; and 16%, gummatous syphilis. Up to 40% of babies born to women with untreated syphilis are stillborn or die from the infection. [Full Text]. [62] The study was designed to measure the progression of untreated syphilis. 1996 Jan-Feb. 23(1):45-50. 1999 Jan. 28 Suppl 1:S21-8. Further, syphilis causes an estimated 520 000 adverse pregnancy outcomes, including approximately 215 000 stillbirths or early fetal deaths, 90 000 neonatal deaths, 65 000 preterm or low birth weight infants, and 150 000 infected newborns . Sex Transm Dis. pallidum . (Right) Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2014 May 9. Identification of congenital infection is often delayed; early recognition and management of congenital infections is important. [Medline]. [Full Text]. [38] A "Fumigation" method of administering mercury was also used, in which mercury was vaporized over a fire and the patients were exposed to the resulting steam, either by being placed in a bottomless seat over the hot coals, or by having their entire bodies except for the head enclosed in a box (called a "tabernacle") that received the steam. In tertiary syphilis, the disease damages your internal organs and … The disease starts as a painless sore — typically on your genitals, rectum or mouth. Br J Vener Dis. This group later discovered the related arsenic, Neosalvarsan, which is less toxic. Immunoperoxidase staining for T pallidum highlights many slender coiled organisms residing in the perijunctional zone. 20 Signs of Sexually Transmitted Infections. Background. [Medline]. 55:1-94. Background. The project, which was conducted by the U.S. Public Health Service (PHS) from 1932 to 1972, examined the natural course of untreated WHO Guidelines for the Treatment of Treponema pallidum (Syphilis). Learn more about the history and legends associated with Saint Valentine. From 2012-2014, the number of congenital syphilis cases in the United States increased from 334 to 458. In addition to standard syphilis and HIV testing, point-of care testing (POCT) will be performed on 1,500 consecutive participants who are being screened for syphilis and HIV and who are at least 16 years old. As a result, the program was terminated, a lawsuit brought those affected nine million dollars, and Congress created a commission empowered to write regulations to deter such abuses from occurring in the future. Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America In acquired syphilis, T pallidum rapidly penetrates intact mucous membranes or microscopic dermal abrasions and, within a few hours, enters the lymphatics and blood to produce systemic infection. POCT will be conducted using a fingerprick whole blood specimen. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. [61] Its use in later syphilis, however, was still unclear. Color Atlas of Sexually Transmitted Diseases. [63], Syphilis experiments were also carried out in Guatemala from 1946 to 1948. Damage to the cortical regions of the brain leads to general paresis, formerly called “general paresis of the insane,” which mimics other forms of dementia. Syphilis. which is a corkscrew or spiral bacterium and is a sexually transmitted disease transmitted by direct contact with ulcerative lesions. Background The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Used with permission from Wisdom (Left) A. Year Book Medical Publishers Inc; 1989. The rate among Hispanic men was 2.1 times that among white men (11.6 vs 5.4), and the rate among Hispanic women was 2.7 times that among white women (0.8 vs 0.3). In 2016, more than 88,000 cases of syphilis were reported in … [Medline]. Syphilis…. Kinetic study of serum penicillin concentrations after single doses of benzathine and benethamine penicillins in young and old people. JAMA. Around half of all pregnancies among women infected with syphilis result in stillbirth or death of the baby shortly after birth. [Guideline] U.S. Preventive Services Task Force. Treatment can help prevent future damage but can't repair or reverse damage that's already occurred. These "national" names were generally reflective of contemporary political spite between nations and frequently served as a sort of propaganda; the Protestant Dutch, for example, fought and eventually won a war of independence against their Spanish Habsburg rulers who were Catholic, so referring to Syphilis as the "Spanish" disease reinforced a politically useful perception that the Spanish were immoral or unworthy. [Guideline] Workowski KA, Berman SM. Syphilis (Treponema pallidum) is one of the most intriguing human pathogens. 2008. 1 Background. Used with permission from Wisdom (Left) A. Non-Hispanic blacks are at higher risk for syphilis than all other racial groups. Syphilis is an infection caused by bacteria which usually spreads through sexual contact. Both syphilis and HIV affect millions of families annually. N Engl J Med. The morbidity and mortality of untreated syphilis must be estimated from the limited data available regarding its natural course. Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological SocietyDisclosure: Nothing to disclose. 33. This website also contains material copyrighted by 3rd parties. These figures have continued to increase since the emergence of the AIDS epidemic, since genital ulcer diseases (including syphilis) are cofactors for the sexual transmission of HIV. 229461-overview
T pallidum is a fragile spiral bacterium 6-15 micrometers long by 0.25 micrometers in diameter.