Christopher Columbus's crew from 1451-1506 contracted a disease. The French called it "the disease of Naples."

John Gunbeck described it as, "...a disease so cruel, so distressing, so appalling that until now nothing so horrifying, nothing more terrible or disgusting has ever been known to earth."

In 1503, Girolamo Fracastro named the disease after a fictitious shepherd who cursed the god Apollo and was afflicted with a new disease by the angered god.

Al Capone died of this disease.

Leo Tolstoy had this disease as a teenager, but treated it with arsenic.

There are rumors that Henry VIII, Vincent van Gogh, and Adolf Hitler suffered from this disease.

New York City has reported an increase in the number of cases of this disease.

The disease is syphilis.

Syphilis has been called the "great imitator" or the "great masquerader." There is enormous variation in the symptoms giving rise to the two names above. There are three distinct stages of the disease.

The first stage - the chancre stage - is the earliest clinical sign of the disease. This is a painless lesion usually on the shaft of the penis, but it doesn't have to be on the shaft. After initial contact, the responsible "bug" - Treponema pallidum - penetrates the mucous membranes. Within hours the Treponema enters the lymph and blood system to cause a systemic reaction. This is long before any other signs appear. In anywhere from 3-90 days, the chancre - the painless ulcer - appears. I have seen the chancre occur on the lips and the fingers in addition to the penis shaft. If untreated, the chancre will disappear in 4-8 weeks, leaving a scar. Syphilis can be spread by touching or kissing or having oral, anal, or vaginal intercourse with a person with an active sore.

The second stage develops in 2-12 weeks. I have seen 2 cases where the secondary stage appeared 12 months later. Although this is rare, it can occur. Patients will present with headache, sore throat, and mild muscle aches. In the past five years, as the Medical Director in Cherry Grove, Fire Island, I saw more cases of syphilis and other sexually transmitted infections than I have in all my training years. I have three theories. One theory is that gay men have stopped using condoms since they feel that HIV can be treated or 'cured.' Second is that a sector of gay men indulge in promiscuous sexual behavior. Third is that many addictions are more common among homosexual versus heterosexual individuals.

I saw an individual with a trunk body rash. He denied any high risk sexual activity. He actually claimed to not have had sex for one year. I gave him antibiotics. I saw the patient four weeks later. He claimed that I had missed the diagnosis of syphilis. How can I even assume he had syphilis if he had been celibate for one year?

After the secondary stage, there is a latent or silent period. There are no symptoms of any infection during this phase. In this early latent stage, the individual can transmit the disease to others. In the third stage of syphilis, the patient is no longer able to transmit the disease to others (4 years after initial contact). Tertiary syphilis afflicts the cardiovascular and nervous systems - especially the brain.

This disease resembles another one also by a spirochete - Lyme Disease. There are three stages of Lyme as there are 3 stages of syphilis. We have epidemic Lyme disease numbers. We have a rise in syphilis due to lack of condom use. Since the gay population is using PREP by Gilead for HIV transmission, less condoms are being used. Gilead does a great job in promoting condoms and safe sex. Gay men need to be educated more about the risks.

Until tomorrow...