STD Awareness: Syphilis Treatment Through the Ages

The spiral-shaped bacteria that causes syphilis.

When syphilis first descended upon Europe, questions surrounded this mysterious scourge. Was it a punishment from God? Was it introduced by a hated Other? Was it caused by the stars’ alignment or the presence of “bad air”? We now know that syphilis is not caused by supernatural forces, foreigners, or a harmful atmosphere, but rather by a species of corkscrew-shaped bacteria called Treponema pallidum, which is spread by sexual contact — vaginal, anal, or oral sex — in which one person comes into contact with a syphilis sore.


Thanks to penicillin, we don’t have to go back to the “good old days” of puke chalices, antivenereal underpants, and rat poison.


Before good treatments were developed in the 20th century, syphilis was the most feared STD out there. Its initial symptoms can include a painless sore filled with a highly infectious liquid. As the infection spreads, lesions and rashes might appear on the soles of the feet or the palms of the hand. After these first waves of symptoms, the infection enters a latent phase, which can lull people into a false sense of security, thinking the disease has disappeared. Unfortunately, 15 percent of people with untreated syphilis reach the late stage, which can occur up to 20 years after initial infection, and includes severe damage to the nervous system, brain, heart, or other organs, and can be fatal.

These days, a shot of penicillin is all it takes to cure syphilis. Back in the day, though, there were myriad “treatments” for syphilis — but they were highly toxic and ineffective. Unfortunately, thanks to the latent phase of syphilis, it often seemed like these treatments did work, which probably explains why folks tortured themselves with them for centuries. If only penicillin had been around: Countless people would have been spared the unpleasant — and often fatal — quackery that syphilis attracted.

Antimony

Antimony is a metalloid that was once used as an emetic (that is, it makes you vomit). Many illnesses were thought to be treated by a good old-fashioned purging, and during the Renaissance era, syphilis was no exception. Cups formulated with antimony were sold as “puke chalices” that reacted with the acid in wine to release antimony molecules, which would cause vomiting. Dosage was difficult to control, however, which meant that sufferers could accidentally poison themselves to death.

If the “puke chalice” is too classy for you, you might have opted for antimony “pills” — solid pellets of antimony — which were taken orally, then retrieved after use and saved for the next round. These reusable pills were even passed down through the generations as family heirlooms.

Mercury

Patient exposed to vaporized mercury in a fumigation stove. Inscription translates to “For one pleasure, a thousand pains.”

Mercury-based syphilis treatments were introduced in the 16th century by Paracelsus, who believed mercury was a cure-all endowed with both earthly and astrological powers. Mercury was already used to treat leprosy, so it made sense that people experimented with its use in syphilis patients — one of the myths surrounding the origins of syphilis is that it came into existence when a prostitute had sex with a leper.

Unfortunately, not only was mercury ineffective in curing syphilis, it had horrible, potentially fatal, side effects. One, excessive drooling, was considered a sign of effectiveness. According to Girolamo Fracastoro — a 16th century physician whose side hustle as a poet saw him coin the name for syphilis — “You will feel the ferments of the disease dissolve themselves in your mouth in a disgusting flow of saliva.” As the reasoning went, the body must have been purging itself of toxins through all that drool. (Nope! Just a reaction to being poisoned.) It also burned the skin, a side effect that appealed to the “no pain, no gain” crowd that believed pain is proof of effectiveness. Sufferers might be expected to endure mercury treatments for the rest of their lives (hence the common saying, “A night with Venus, a lifetime with Mercury”).

The creativity with which mercury was administered is almost inspiring. It could be added to fat and rubbed directly into a syphilis sore or used to line the insides of antivenereal underpants. Mercury could be heated in a fire, and a patient might breathe in the vaporized mercury or sit in a stove with their head poking out for their body to be “fumigated.” Mercury-based ointments were still used during World War I in the hope that rubbing them on genitals would prevent STDs after potential exposure.

Almost There: Arsenic

You might think of arsenic as the active ingredient in rat poison, but it also enjoys a storied history in the treatment of syphilis. In 1786, Fowler’s Solution, a lavender-flavored potion made of 1 percent arsenic, came on the scene, and for 150 years it dominated syphilis treatment. Arsenic did dilate capillaries in the face, giving patients a rosy glow that many people mistook for a sign of improved health, but it didn’t actually cure syphilis.

Arsenic wasn’t a lost cause, though. In 1910, scientists led by Paul Ehrlich synthesized an arsenic-based drug called Salvarsan. It had to be given in small doses to avoid its toxic effects; it also had many unpleasant side effects, ranging from rashes to liver damage. Two years later, Neosalvarsan was released, with milder side effects, and was hailed as a “Magic Bullet” by journalists. Ehrlich went on to win the Nobel Prize for his discovery.

Unfortunately, this treatment regimen came with a hefty price tag and could take weeks, months, or even more than a year to administer — obstacles that kept a great number of quack doctors in business. Various tonics, “blood purifiers,” treatments involving electric shock, and other alternative remedies were popular, but ultimately ineffective.

Finally, Penicillin

When penicillin came on the scene in the 1940s, syphilis could once and for all be cured quickly and inexpensively, and with very few side effects. It was hailed as a “New Magic Bullet,” and its development was part of the Allies’ path to victory during World War II. (The prophylactic mercury ointments given to soldiers during World War I weren’t good enough — STDs had then been the cause of 7 million sick days taken by soldiers.)

Unlike gonorrhea, which quickly evolved resistance to penicillin and most other antibiotics, syphilis is still easily slain by an intramuscular shot of the drug. Although resistance to another class of antibiotics, macrolides, is emerging, penicillin remains the go-to drug for syphilis. While it’s possible that syphilis could develop resistance to penicillin in the future, its continued susceptibility after 70 years of use suggests that penicillin resistance requires a complicated series of mutations — so we’re safe for now! And thank goodness, because we can’t ever go back to the “good old days” of puke chalices, antivenereal underpants, and rat poison.


You can get tested for syphilis and other STDs at a Planned Parenthood health center. It’s important to catch syphilis in its early stages, as any damage it does to your body is irreversible.

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