Syphilis is a sexually transmitted infection caused by the spiral-shaped bacterium Treponema pallidum. Before effective modern medicine, this disease was a significant global health threat. Due to its severity and widespread impact, it earned the nickname “The Great Pox”. Initial infections were often aggressive, leading to severe symptoms and death in the acute phase. Many sufferers endured decades of illness before succumbing to its long-term complications.
The Pathology of Fatal Syphilis
The infection begins with the primary stage, marked by a painless sore called a chancre at the site of entry, which heals spontaneously. This is followed by the secondary stage, where a generalized rash and flu-like symptoms may appear before resolving. The disease then enters a latent stage, which can last for years or decades without symptoms, though the bacteria remains in the body. For an estimated one-third of untreated people, the infection progresses to the tertiary stage, where severe and irreversible damage begins to affect multiple organ systems.
The fatal outcomes of tertiary syphilis result from two major forms: cardiovascular syphilis and neurosyphilis. Cardiovascular syphilis appears ten to thirty years after the initial infection. The inflammatory process specifically targets the vasa vasorum, the small blood vessels that nourish the aorta’s wall. This sustained damage causes the aorta’s tissue to stretch and weaken, a condition known as syphilitic aortitis.
This weakening often manifests as an aortic aneurysm that can press on surrounding structures or burst suddenly. Furthermore, the inflammation near the aortic valve can lead to aortic regurgitation or narrowing of the coronary artery openings, known as ostial stenosis, severely compromising heart function. These long-term cardiovascular issues represent the infection’s most frequent method of causing death.
In the nervous system, the late-stage infection causes devastating syndromes like neurosyphilis, which attacks the brain and spinal cord. This can involve meningovascular syphilis, where inflammation of the blood vessels supplying the central nervous system results in stroke. The most severe form is General Paresis, a chronic meningoencephalitis that destroys brain tissue, resulting in symptoms such as delusions, mood swings, and memory loss. Another form, Tabes Dorsalis, damages sensory nerves in the spinal cord, leading to loss of coordination and paralysis.
Notable Historical Figures
Before modern antibiotics, long-term complications of syphilis claimed the lives of many notable figures. Al Capone, for instance, succumbed to neurosyphilis in 1947. His health rapidly declined while incarcerated, and he developed general paresis, a form of late-stage neurosyphilis characterized by severe dementia and psychosis. Though his official cause of death was listed as cardiac arrest, it was a direct consequence of the neurological and cardiac damage caused by the chronic infection.
The French Post-Impressionist painter Henri de Toulouse-Lautrec is another figure whose life was cut short by the infection. He died in 1901 at the age of 36 from complications attributed to advanced syphilis and alcoholism. His case illustrates how the disease destroyed the health of individuals across all social strata in the late 19th century.
Ragtime composer Scott Joplin also died from the devastating effects of neurosyphilis in 1917. Joplin spent his final years suffering from dementia paralytica, a severe form of the disease that resulted in mental and physical breakdown. The infection ultimately led to his institutionalization and death, leaving many of his musical manuscripts unfinished or destroyed. These cases highlight the era when a syphilis diagnosis carried a near-certain risk of a slow and debilitating death.
Syphilis Mortality in the Modern Era
The landscape of syphilis mortality changed with the widespread introduction of penicillin in the mid-20th century. This antibiotic proved effective, quickly curing the infection in its early stages and preventing progression to the fatal tertiary phase. Consequently, death from syphilis became a rare occurrence in countries with access to modern healthcare, transforming the disease from a chronic killer into a curable infection.
Despite this medical advance, syphilis-related deaths have increased in the United States in recent years, rising by approximately ten percent annually between 2015 and 2020. Hundreds of deaths were attributed to the infection, often where the disease was not diagnosed or adequately treated. A significant portion of these modern deaths are linked to co-morbidities, with many decedents also having an HIV diagnosis. Syphilis increases the risk of acquiring HIV and can complicate its management, contributing to a fatal outcome.
Congenital syphilis occurs when the infection is passed from a mother to her unborn child. The lack of timely prenatal care and screening among pregnant individuals is the primary failure, as a single course of penicillin can prevent transmission to the fetus. When untreated, the bacterium can cause a range of outcomes for the infant, including stillbirth, premature delivery, and organ damage, which elevates the risk of death in the first year of life. This preventable tragedy highlights systemic gaps in public health outreach and access to care.