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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (Jan. 1, 1988)
The new syphilis BONNIE L. JACKSON, R.N., CDC R ecovery T h era p ist Individual • Couples • Families Relapse Prevention, Consultation Let’s face it, when you get the clap or something, you go straight to the clinic. Most private physicians have never seen a case o f syphilis. I’ve made a deal with my doctor, though. If he’ll keep an open mind, I’ll give him plenty to read. _Y___ M I 2311 E. B u rn sid e, S u ite 101 P o rtla n d . O reg o n 97214 232-1233 C L A R I C E JOHNSTON D. M. D. D E N T I S T R Y for adults and children • Treatment explained and discussed • Weekdays, Evenings and Saturdays • Flexible payment plans • Nitrous oxide available • New patients welcome 233-3622 230 N.E. 20th (Three blocks north of Burnside) Just Out • 10 • January |988 K E S M I T H ut I’ve never had syphilis,” Tom said, putting the magazine down. “ Are you HIV positive?" I asked insistently. "Y ou know la m ." "T hen you may have had syphilis," I argued, picking up the magazine. "According to this article in the January Atlantic, you may have syphilis now.” I handed him the magazine again. “ W hat’s more, it may he syphilis that’s killing you. not HIV." My last remark came too quickly, I could tell. It was one thing to ask Tom to believe that, in addition to HIV, he had syphilis. It was too much, though, to expect him to believe it was syphilis alone. " B u t . . . but," he sputtered, so many ques tions trying to get out at once, "w hat aTxmt HIV? Did scientists discover the wrong bug? And if 1 have syphilis, why hasn’t my doctor picked up on it? The last time I went to the clinic my VD tests were negative. W ell?" I paused. Was I ready to beat my head against the wall again? A year of reading medical jour nals and talking with medical researchers, the connection and came across McKenna’s doctors and clinicians had taught me one thing article ( ‘ Unmasking AIDS: Chemical Immuno at least. You’ve got to separate the know-it-alls suppression and Seronegative Syphilis,’ from those with an open mind or you’ll go Medical Hypotheses, December 1986). I was crazy. One doctor at the VD clinic had not read stunned. I had to talk to her. So I tracked her an article on syphilis in fifteen years. He didn’t down and went to see her a couple of days even know that syphilis invades T cells and later.” suppresses the immune system! "Ju st like that." "W ell," 1 continued hopefully, "theorists "Ju st like that. Our meeting was the most suggest HIV may be just a component of informative two hours I ever spent. She knows syphilis. You see, the syphilis you and I were more about syphilis than anyone. She got me taught about is not as simple as we thought. started on the medical journals and has listened Remember the three-stage thing? You know, patiently to all my arguments since." the primary stage of a lesion, followed by " S o let’s get to the nitty-gritty. What did secondary and tertiary stages where syphilis you do?” progresses from a skin rash to a wholesale “ Well, after plenty o f reading and talking — invasion o f your vital organs? and listening — I found a doctor in Palo Alto "Y eah. I read all that." who was one step ahead o f me. He believed "W ell. I had that kind of syphilis when I was enough in what McKenna was saying to try out 19," I said, almost casually. " I got a lesion, got some high doses of penicillin. tested then treated with the standard shot o f 2.4 “ How high?” Tom asked hesitantly. million units of penicillin G benzathine. " 2 0 to 40 million units a day. Aquaeous Imagine my shock when I learned just six penicillin in an IV drip." months ago that the treatment may have been "Jesu s, that much!” inadequate. That it might only have masked the “ Yep. Anything less may mask it again. syphilis, driven it underground. There’s a latent Though, I must admit. I’m still not sure whether form o f the thing, you know, that can sit around it’s the amount or the duration." in your tissues, biding its time, waiting to go "W h at do you mean?” back to w ork." Tom stared at me. silent. “ Did "W ell in Germany they’re using these big you know,” I continued, my voice getting doses in continuous IVs over a three-week louder, "th e Russians take two years to treat a period. In New York there’s a doctor who’s case of syphilis, the Italians one year? claiming success with the more conventional Europeans have long criticized our short-term oral penicillin over several months. Penicillin approach.’ ’ kills syphilitic spirochetes only when they’re Tom paused then shrugged. " S o why can’t reproducing, so how much penicillin and how we just go the clinic and get tested? I don’t see long is still up in the air. And, o f course, each the big deal ." individual's situation is different." "A nother dilemma,” I announced, eager to " S o what happened after your treatment?" share what else I’d learned. "It seems the "W ell, about three weeks after I finished, I standard syphilis tests are increasingly had blood work done and. guess what?” unreliable. The Journal o f the American Medi “ Yeah?" cal Association (January 16. 1987) suggested "Y eah. Things improved for the first time in that such tests may no longer be valid, particu about three years. Various parameters started to larly in persons with compromised immune show normal or closer to normal. And my systems. Sound fam iliar?" physical symptoms improved. The thrush has Tom grew quiet. I could see I was getting all but disappeared and my energy and weight through "H ow did you get on to this?" he are normal " finally asked. " S o you’re . . . ‘cured’? " Tom asked '' W ell. the New York Native has been a hesitantly, fishing around for the right word. champ about it. Since last February they’ve ‘Whoa! Not at all. I mean, it’s only been a promoted the theory It really started, though, couple of months. I m still not even testing w ith a medical researcher in Berkeley named positive for syphilis " Joan McKenna.” I reached for the Atlantic ‘You mean you went through all this without again. even knowing whether you had syphilis?” " I know. I know , it’s all in here ’ ’’ Tom said Remember what I said about the tests. impatiently. "S o what happened?" Listen. One o f the guys in our group was really "A friend o f mine knew I was interested in out in left field. Like you. he had never had B syphilis. When he’d been diagnosed with KS a couple o f years ago, he took the veil and began the Big Search. He too found McKenna. Then, about a year ago, he went to this doctor and did three weeks o f IV penicillin. His KS lesions started to disappear and he developed what appeared to be a syphilitic rash. But he was negative on the tests! So he went through the whole thing again seven months later. And finally, ten months after his first treatment he shows positive on the tests. He was so excited when he called me, ‘I’ve got syphilis. I’ve really got syphilis!’ ” “ So his immune system was starting to kick in?” “ Exactly. He had been so shot — and the syphilis was so subtly buried — he didn’t even test for it. But after two courses of IV penicillin his immune system became normal enough for him to test positive. Take my case. Following my first bout with syphilis, I was diagnosed again in 1972, then again in 1973. And of course, treated both times. Then in 1975 I was diagnosed again, only now it was ‘early latent’ syphilis. I was treated again. Then diagnosed one more time in 1976 (again ‘early latent’) and treated again. Now even though my sexual practices didn’t change until ‘safe sex’ of the early ’80s, I supposedly never contracted syphilis again. In fact I remember saying to a friend about 1982 that it seemed strange that I was no longer catching syphilis. ‘Have I become immune?’ I asked naively. Well, now I know it was either the same case all along or perhaps several cases in several stages, all becoming less typical, less trackable, less treat able. Finally, about three weeks after this new treatment with IV penicillin, along comes a rash. I guessed what it was, but I wanted as many opinions as I could get. I even called G erm any." “ G erm any?” "Y eah, there are two doctors there who started using IV penicillin on AIDS patients in 1981, though they thought at first it was endocarditis due to gonorrhea. They told me many of their patients had developed a rash. Well, the rash, they say, is secondary syphilis ( ‘awakened’ from latent syphilis) being excreted through the skin. A doctor in New York agreed and added that it might be complicated by staph. Mine comes and goes but appears to be fading." "S o , you’re cured?" Tom repeated. “ No, no. I ’m reprieved . . . maybe. I ’ll wait a few months, get some more blood work, and, who knows. I may have to watch this thing the rest o f my life.” “ Well,” Tom concluded, drawing in a breath. "T h is is all a bit much. I ’m not sure what to make o f it.” * ‘ I can tell you one thing. If you walk out that door and start yelling ‘syphilis!’ they’re going to think you’re crazy. And if enough people tell you you’re crazy, you’ll start believing it. Take this to your doctor,” I said, making him a pres ent o f the Atlantic. “ Ask him if he has an open mind. Tell him you’ll bring him the research if h e’ll read it. You know, the drug and medical establishments stand to lose face — and money — if it turns out to be syphilis. So be ready for the worst. But tell him too you’ve only got one body to leave to science and you’re not ready to part with it yet. O K ?” • Mike Smith was diagnosed ‘ ‘with something’' last summer. He has become an AIDS activist, speaking before various groups about the syphilis connection. He can be reached at (415) 552-1358. In addition to the references mentioned above, he suggests the following reading: New York Native (most issues since February 1987), the British Journal o f Venereal Disease (most issues o f the last fifteen years), the New England Journal o f Medicine (June 18, 1987), Pathogenesis and Immunology of Treponemal Infection by Schell and Musher (Marcel Dekker, New York, 1983), and No Magic Bullet, A Social History o f Venereal Disease in the United States since 1880 by Allan M. Brandt (Oxford University Press, 1987). Joan M cKenna heads the Institute of Thermo- baric Studies, 2811 Martin Luther King Jr. Way. Berkeley, Calif. 94703.