CHRONIC Syphilis and Lyme Disease:

a Comparison

In this 4 minute youtube, Alan MacDonald holds up a copy of Modern Clinical Syphilology, by John H. Stokes, published in 1945, and says, "Everything you want to know about Lyme Disease is in this book."

Since this book was the main medical text I used for my book Pox: Genius, Madness, and the Mysteries of Syphilis, and since I had been comparing the symptoms of syphilis in the days before penicillin with those of Lyme Disease today, I emailed him immediately and we enjoyed a correspondence.

A brief summary comparison:

Syphilis:

Before 1943 when penicillin was discovered to be a treatment for syphilis, the disease was epidemic in the United States, with estimates between 10 and 15% infected. Patients would go to many doctors seeking a diagnosis before finding a syphilis specialist and being treated with limited success with toxic medications. Without reliable laboratory tests, diagnosis of chronic disease was made based on a careful history noting symptoms and progression over time. After initial infection the pathogen, a spirochete, would enter the blood, reproduce, and then wiggle its way to all parts of the body. Soon after infection, flu-like symptoms would appear -- fever, headache, malaise, joint pain. Called "The Great Imitator" because of its facility to imitate almost any disease, syphilis would go through a period of latency and apparent cure, appearing years and decades later, moving from one system of the body to another--including the skeletal system, the gastrointestinal tract, the liver and spleen, the cardiovascular system, and the nervous system. In 1913 Noguchi found syphilis spirochetes (Treponema pallidum), in the autopsied brains of patients with late neurosyphilis.

Lyme:

2018: the CDC posted that Lyme, an emerging disease, is the most commonly occurring vector-borne disease and the sixth most commonly reported notifiable infectious disease, changing its estimates from 30,000 to 300,000 new cases a year. Patients go to many doctors seeking a diagnosis before finding a Lyme specialist and being treated, often with limited success, with repeated courses of various antibiotics. Without reliable laboratory tests, diagnosis of chronic disease was made based on a careful history noting symptoms and progression over time. After initial infection the pathogen, a spirochete, enters the blood, reproduces, and then wiggles its way to all parts of the body. Soon after infection, flu-like symptoms appear -- fever, headache, malaise, joint pain. Called "The Great Imitator" because of its facility to imitate almost any disease, Lyme goes through a period of latency and apparent cure, to reappear years and decades later, moving from one system of the body to another--including the skeletal system, the gastrointestinal tract, the liver and spleen, the cardiovascular system, and the nervous system In 1985, following Noguchi, MacDonald found Lyme spirochetes, Borellia bergdorferi, in autopsied brains.

what is modern clinical syphilology?

A 1945 review of Stokes Vol III, saying that this book should be in the possession of every deramtosyphilologist (Dermtaology and Syphilology were combined disciplines then), praising Stokes and his new co-authors for having reduced the typeface and the edition to small print and 1,332 pages.

Who is alan macdonald?

what is the Time period of the comparison?

1. Syphilis: In 1871 Sir Jonathan Hutchinson gave a speech, "Syphilis as the Great Imitator," for the first time linking many of the illnesses of late syphilis to the early infection. (Note: Sir Jonathan published 1,200 articles, in addition to his books). Syphilis was in incurable disease until 1943 when E. F. Mahoney of the US Public Health Service discovered that penicillin could eradicate an early syphilis infection. 1871-1943.

2. Lyme: In 1975 in Lyme, Connecticut, a new disease was discovered and named after the town where it was first seen. Antibiotics cure an early infection. 1975-2018.

How many people are infected?

1. Syphilis: The United States Public Health Department put considerable resources behind syphilis because an estimated 15% of the population was infected with a disease. In 1940, that would have been about 20 million people. To put that number in perspective today, without penicillin in the US the number would be 50 million. There was hope that syphilis would be eradicated in the United States but in recent years the number has crept up to 75,000 diagnosed cases. Worldwide the number is much larger.

2. Lyme: The CDC recently increased their estimate of Lyme Disease from 30,000 cases to 300,000 cases annually. This translates to 1 million new cases even three plus years. More attention is being paid to LD because of the rapid increase in cases.

Who did/is doing the research?

1. Syphilis: With the support of the U. S. Public Health Service, five universities joined as the Cooperative Clinical Group to pool data on their studies of all the stages of syphilis.

The five universities and the directors were 1) Mayo Clinic (Paul A. O'Leary), 2) University of Michigan (Udo J. Wily), 3) University of Pennsylvania (John H. Stokes), 4) Johns Hopkins (Joseph Earle Moore), and 5) Western Reserve (H.N. Cole).

John H. Stokes used the data from this joint study in the revised third edition of MCS. According to him, 75% of the material had been added since the second edition. Vol III has 1,335 pages of small print.

2. Lyme: with the growing number of cases, more attention is being focused on gathering clinical data.

lymedisease.org launched an online patient questionnaire data base that is approaching 10,000 responses and 1 million data points.

The National Science Foundation (NSF) has awarded a three-year, $800,000 grant to explore predictive analytic techniques using data collected by the MyLymeData patient registry.

Drs. Deanna Needell (Professor of Mathematics at UCLA) and Blake Hunter (Assistant Professor, Claremont McKenna College) Researchers at the University of California Los Angeles will collaborate with LymeDisease.org on this data project.

The comparison: the CCG data was comprised of data collected by physicians in universities, the data was handwritten, and the number of patients studied was larger. Example, one study of cardiac syphilis had 60,000 participants. Also, the CCG included autopsy results. The NSF study is patient generated and computerized.

A comparison of the spirochetes of syphilis and Lyme

In 2013 Scientific American published "On the Curious Motion of Syphilis and Lyme Disease." A video near the end of the article shows the sine and cosign shaped movement of the two very similar bacteria side by side, like synchronized swimming.

These long, thin organisms can squeeze through tiny spaces. In this article, Jennifer Frazer wrote:

"Inside us, they can drive pretty much wherever they want . . . Syphilis and Lyme Disease are better at penetrating our bodies than almost any other organisms. Spirochetes cross barriers that are impenetrable to almost anything else, including basement membranes and the linings of organs like intestines called endothelium that function to keep the kajillions of bacteria in your gut out of the rest of your body. In humans, syphilis and Lyme Disease bacteria easily penetrate the normally sacrosanct blood-brain barrier to infect the central nervous system. Syphilis can invade the placenta and infect an unborn child."

A comparison:

1. The Lyme spirochete has more flagella and can swim through more viscous liquids.

2. The have some but not all genes in common.

3. The Lyme spirochete can be cultured outside a mammalian host; the syphilis one cannot..

The discovery of the two spirochetes

1. Syphilis: The syphilis spirochete was first seen under a microscope by Fritz Schaudinn, a parasitologist of ducks and owls, in 1905. Before that there were many bizarre hypotheses of what caused the disease. (Add notes from Pox). Schaudinn named the organism Treponema pallidum

2. Lyme: The Lyme spirochete was named Borrelia burgdorferi after Willy Berdorferi who say it under his microscope in 19xx.

The vector of transmission

1. Syphilis: is an STD. The spirochete is anaerobic and can't live outside a liquid medium very long. It requires bodily fluids to spread infection from one person to another.

2. Lyme: Lyme is spread by ticks that attach to humans with pinchers and spread spirochetes from their midgut in their saliva. Nymph ticks the size of a sesame seeds are more dangerous than mature ticks.

The first signs of infection

1. Syphilis: Soon after infection, a sore or chancre appears at the site of inoculation. After that a full body diffuse red rash appears, including the palms of the hands and the soles of the feet. The rash may be mild or severe. Stokes devotes two long chapters to the initial chancre and the rash.

2. Lyme: no chancre appears but a localized red bull's eye rash surrounds the bite.

And sometimes in both diseases there is infection with no chancre or rash.

The medical Specialties

1. Syphilis. In 1932 The American Board of Dermatology and Syphilology was incorporated. The two specialties were combined because of the prevalence of skin lesions in various stages of syphilis. In 1955, the official name of the Board was changed to the American Board of Dermatology.

A personal note: I enjoyed many afternoons visiting with Dr. Eugene Farber between patients at his Palo Alto psoriasis clinic when I was researching my book Pox. Dr. Farber was a board certified Dermatologist and Syphilologist who had researched syphilis at the Mayo Clinic before joining the Stanford faculty in 1949, later becoming chairman of the Department of Dermatology. He said the most important advice he could give when considering a diagnosis of late syphilis was "Always look for the prodrome."

2. Lyme. Doctors who specialize in the treatment of Lyme are popularly called "Lyme Literate."

The Infectious Disease Society of American (IDSA) sets guidelines for diagnosis and treatment of Lyme.

The Lyme Association and the International Lyme and Associated Diseases Association provide education about Lyme Disease. The Lyme Association publishes Lyme Times.

ILADS has proposed guidelines contrary to those published by IDSA. The issue is contentious.

What is the secondary stage of spirochetal disease?

With both syphilis and Lyme, after the spirochete enters the body , it reproduces rapidly and spreads via the blood to all parts of the body (except hair, fingernails, teeth and the lens of the eye), including the brain.

Syphilis: According to Stokes early signs of infection are:

* Fever, chills, headache, fatigue, malaise and joint aches, and swollen lymph nodes.

Lyme: According to the CDC, the first signs of Lyme infection are:

* Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes.

how long does a spirochetal disease last?

Syphilis: Stokes calls syphilis "a relapsing disease par excellence." He cites many cases where tertiary disease (in particular neurological and cardiac manifestations) happening decades after infection.

how long should a spiochetal disease be treated?

Syphilis: Before penicillin, syphilologists would treat relapses with different types of spirillicides--mostly heavy metals like mercury or the arsenicals-- for decades.
As early as 1887, Sir Jonathan Hutchinson advocated using mercury after observing the prodrome of paresis. He wrote (p 513 of Syphilis ):
"In cases when there are the premonitory symptoms of general paralysis of the insane, I have for long been in the habit of advising the continuous use of mercury for years. In doses of from half a grain to a grain of the hydrargyrum cum creta three times a day, and in combination, if need be, with a tonic, this drug may be given continuously for many years together, not only with impunity, but with great advantage to the general health.”
Aware of a delicate balance between the horrors of the disease and the side effects of continuous use of mercury and arsenic, Stokes wrote of the need for awareness of the balance between "the tonic and the toxic."
Lyme: today a main debate between the IDSA and the Lyme doctors has to do with the length and frequency of courses of antibiotics.
Lyme doctors often recommend long courses of different antibiotics, both orally and intravenously.
The IDSA considers six months adequate and warns against the overuse of antibiotics, with concerns for the patient as well as to guard against antibiotic resistence and the creation of superbugs.

From the CDC: Later Signs and Symptoms (days to months after tick bite)

Severe headaches and neck stiffness
Additional EM rashes on other areas of the body
Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
Facial palsy (loss of muscle tone or droop on one or both sides of the face)
Intermittent pain in tendons, muscles, joints, and bones
Heart palpitations or an irregular heart beat (Lyme carditis)
Episodes of dizziness or shortness of breath
Inflammation of the brain and spinal cord
Nerve pain
Shooting pains, numbness, or tingling in the hands or feet
Problems with short-term memory

what are the guidelines for treatment?

Syphilis: because syphilis could imitate almost any disease and symptoms moved from one part of the bod to another over a long time period with periods of latency, there were no guidelines for diagnosis and treatment, other than the many textbooks and articles that were written. Syphilologists took long patient histories to find clues to this most protean of diseases and tailored a treatment plan to the patient. Often a patient would have seen many doctors over many years, sometimes having undergone many unnecessary surgeries before find a syphilologist. Stokes wrote:

detective zeal.

Lyme: at present there are two competing guidelines for diagnosis and treatment of Lyme.

1. The IDSA.

The guidelines were written to recommend a short course of generic drugs for a brief period of time. 2006 guidelines were reviewed after the attorney general of Connecticut We stand 1000% behind the guidelines. Two weeks of antibiotics. Long term antibiotics, resistant superbugs, upset of GI tract. More often than not a diagnosis of Lyme is incorrect.

2. ILADS.

ILADS recommends antibiotic retreatment when a chronic Lyme infection is judged to be a possible cause of the ongoing manifestations and the patient has an impaired quality of life.

richard whitley --

some errors on the idsa website

Lyme disease is caused by bacteria called Borrelia burgdorferi that is only transmitted to humans when they are bitten by an infected tick. *** Wrong — a baby can be infected in utero. And infected blood can spread disease.
To infect its host, a tick typically must be attached to the skin for at least 36 hours. *** Wrong.
The most common symptoms of Lyme disease include a red, circular “bulls-eye” rash often accompanied by muscle and joint aches. *** Wrong: fever is one of the main symptoms.
Most cases of Lyme disease are successfully treated with a few weeks of antibiotics. *** Wrong: spirochetes can hide in treponemal sanctuaries like the viscous liquid of the eye, can hide as cyst forms, and can hide in biofilms. Then, when conditions are favorable, they can reemerge as motile spirochetes and cause a relapse.
In 2016 there were over 58,000 cases of Lyme disease reported in the US. *** The estimate is outdated. In 2018 the CDC increased their estimate to 300,000 cases. Andmillions of caes worldwide.