The Great Imitator

The scourge of syphilis re-emerges, deadlier than before

"There's just too damn much anonymous sex going on out there," grouses Lydon. "During previous outbreaks you could look at a map of St. Louis and see disease clusters. Now if you look at a map, you'll have dots all over the place. We don't know if it was a cluster. We don't know if they had sex with each other, because most of them say it was anonymous.

"We've hit a real roadblock."


Legally bound to protect patient confidentiality, Lydon is careful to withhold personal information about cases his department handles. He tenders information haltingly, as though running each case through a mental sieve of legality. There is, however, one piece of information he'll freely proffer: Last fall a number of men flew into St. Louis from Dallas, Chicago and Los Angeles for the sole purpose of attending an orgy.

Sound far-fetched? Think about it, says Lydon. "Cheap airfare. If you're going to spend $39 on airfare to have a guaranteed sexual encounter, that becomes less expensive than going to six different bars over the course of a Friday and Saturday night. Buying people drinks? That 40 bucks [airfare] is a lot cheaper -- and the sex is guaranteed."

Of course, investigators would have remained unaware of the party had it not been for the rash of men who visited their doctors late last fall with syphilitic lesions. Physicians are legally bound to report all instances of STD infection to the state health department, and upon noting the outbreak, Lydon dispatched his investigative team. They managed to contact the vast majority of those who reported infections. What they found was troubling.

"They were African-American and white. All were professionals -- full-time, job-holding, home-owning individual males. All identified themselves as men who have sex with men between 30 and 50 years old," says Lydon. "We were dealing with a very well-educated population, who among other things understood the importance of knowing their [HIV] status."

But for all of this population's perceived affluence and education, its members were to a man uncooperative. While most of those infected admitted they'd participated in an orgy, very few named sex partners.

"Did they know each other? Since they were all at the same party, I'm assuming yes," Lydon says. But he can't be certain. "The stock answer was: 'If there's anybody [who might be infected], I'll take care of it.'"

The investigation foundered. Though his team managed to determine that "dozens" of men had attended the orgy, investigators never discovered the date or location. Because so few partners were named, health workers were unable to contact untold others who might have been infected as a result of the party but hadn't seen a doctor.

They knew that since the outbreak followed the party, whoever brought the disease had flown in from another city. They also knew that the carrier had himself recently contracted the disease.

"Did they have a penile lesion? Probably not," Lydon theorizes. "With as many people who were infected at that party, I would lean toward the thought that he had an oral lesion and was giving oral sex to multiple men."

In the end Lydon's team had to move on. Still, he knew St. Louis hadn't seen the last of that syphilitic strain.

"There were other cases popping up, but the community wasn't talking," the epidemiologist says. "So I can't give you that nice clean and tidy ending that I would have liked to have seen myself. It's been bubbling under the surface. Honestly, I think it was a precursor to what was about to happen."


First, an aside: While reading the paper at his breakfast table one morning, Saul Rabinowitz came across an item that shocked him.

"Mitzi!" he exclaimed. "The world is such a dangerous place. Like the syphilis! Oy! It's killing people!"

Patient Mitzi replied, "Saul, honey, don't worry. I read about the syphilis in the encyclopedia -- you have nothing to worry about."

"Why not?"

"It only affects the Gentiles."

Mitzi's misconception goes a long way in explaining the so-called Columbian School theory, which holds that syphilis did not exist naturally in Europe but was introduced to the continent in the late fifteenth century by Columbus' crew following a sex-fueled visit to Hispaniola, now known as Haiti. The other dominant theory, held by the Pre-Columbian School, maintains that syphilis has always existed in Europe. With few exceptions, the disease does not prey on other species. According to the pre-Columbians, early syphilis was often confused with other diseases, such as leprosy.

The uncertainty can perhaps be forgiven. Part of the difficulty in diagnosing syphilis is that its symptoms are diverse and easily confused with those of other diseases. This chameleonic quality has earned the ailment the nickname "The Great Imitator" and prompted the early-twentieth-century physician Sir William Osler to famously remark: "He who knows syphilis, knows medicine."

Infection produces a single painless lesion. It is in this so-called primary stage that syphilis is most infectious. The lesion appears at the site of infection, which means ulcers inside the vagina, rectum or mouth may easily go unnoticed. After the initial lesion heals, the skin erupts with secondary syphilis -- a particularly gruesome stage that manifests as a splotchy rash or the dreaded Condylomata lata, a discolored, wartlike growth that spreads around the area of infection.

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