A small, painless sore in the genital area, often unnoticed – and quickly forgotten, since it disappears after a couple of weeks: that’s the way syphilis presents in the beginning stages. For many years, it was thought that the disease was under control in Germany. But now it’s on a sharp rise: with 3,700 new cases last year, levels are back up to where they were in 1986.
The rise has mainly been recorded in big cities like Cologne, Frankfurt and Berlin. However, the condition -- which Columbus’s men are thought to have brought back from America in 1492 -- no longer carries the terror it once did, when it claimed many prominent victims including alleged sexual superman Giacomo Casanova (1725-1798), German philosopher Friedrich Nietzsche (1844-1900), and composer Ludwig van Beethoven (1770-1827) whose loss of hearing has been ascribed to the disease.
Treating syphilis with penicillin – if the condition is caught early enough – is usually successful. One problem associated with syphilis bacteria however is that they can damage mucous membranes which in turn can make them more susceptible to the HIV virus.
"We were surprised by the rise in the figures because the number of syphilis cases was stable in the last few years, in fact in 2010 there were fewer cases," says Viviane Bremer, a syphilis expert at the Robert Koch Institute in Berlin.
Breme says that in Germany the disease mainly affects men who have sex with male partners. “We don’t know the reason for the rise in the number of cases,” she says. One could be that people get tested more often, Bremer explains, adding that it is purely speculative to draw the conclusion that less sexually responsible behavior is the cause for the rise in syphilis cases.
The disease is a sneaky one. After the initial and often unnoticed phase following infection that appears to go away on its own, syphilis enters a second phase a few weeks later with patients suffering from fever, loss of appetite, and an itchy rash. They just feel generally sick. Following that phase, the syphilis then takes another ostensible “break.”
Many think at this point that they’ve gotten rid of the disease – and indeed in a third and sometime up to one half of cases, it really does clear up. But the impression can also be deceptive, and without treatment syphilis can cause severe long-term damage to the inner organs, blood vessels, heart, central nervous system, skin and brain. This can spread out over decades, “but only in isolated cases is syphilis diagnosed so late that permanent brain damage results,” Bremer explains.
There is no vaccine for syphilis, and those who have had it once can get it again. In its 2012 HIV report, non-profit AIDS association Deutsche AIDS-Hilfe states that “identifying syphilis early, therapy, partner information, and prophylactic treatment for partners, are therefore indispensable to prevention.”
With syphilis, statistically, one in three sexual contact with an infected partner results in infection. Condoms offer a good level of protection against syphilis, although Bremer warns that “while important but they will not protect you 100%” since syphilis has also been known to be transmitted by kissing.
In Germany, syphilis is a “man’s disease:” over 93% of new cases are male, and only 6.4% female. In Eastern Europe, on the other hand, significantly more women than men are diagnosed with the disease. Why? Bremer believes that the true numbers of male sufferers are not known there because homosexual activity is still a taboo in Eastern Europe so men would be less likely to report a condition linked to it.