Symptoms of AIDS could be syphilis in disguise

Researcher says methods for syphilis testing inadequate

By COLMAN JONES

NEW YORK - On a cold December afternoon, a select group of 30 AIDS activists, scientists, physicians and journalists, armed with stacks of scientific papers and medical textbooks, gathers in the plush boardroom of a Manhattan ad agency to discuss some highly controversial findings that threaten to alter fundamentally the direction of AIDS research.

These dedicated investigators have uncovered disturbing evidence suggesting a chronic form of syphilis may be ravaging - undetected and untreated - the same populations affected by AIDS.

The meeting, organized by two New York AIDS groups, is opened by Joan McKenna, a San Francisco researcher who was among the first to draw attention to this issue.

"The AIDS epidemic may just be the tip of a much bigger epidemic of syphilis," she warns, "and neither the public health sector nor private physicians are prepared to deal with it."

Syphilis search

Syphilis, transmitted through intimate sexual contact, is commonly thought easy to diagnose and treat. The initial phase can produce a sore called a chancre. Secondary syphilis can result in rashes, fevers and sore throat. These symptoms may go unnoticed, however, and the disease can then lie dormant in a chronic, latent state.

McKenna's group, the Biological Assessment of Syphilis and Immune Suppression Project (BASIS), has conducted extensive searches of medical records comparing untreated, chronic syphilis cases to current AIDS cases.

"We found that individuals with a history of syphilis, and who had unresolved syphilis still in their system, would show the same signs and symptoms that we were seeing in people today who had the diagnosis of AIDS," reports McKenna.

As it turns out, syphilis - long known as the Great Imitator - can mimic a number of other diseases as well. All the same, this uncanny overlap with AIDS symptoms intrigues John Scythes.

Scythes, a former housing contractor who now runs Toronto's Glad Day Bookshop, has spent years combing through classic syphilis texts and hundreds of scientific papers, tracing the connection between syphilis and AIDS.

"Hall's Actuarial Reports, an insurance underwriter's manual in the 1940s, documented considerable mortality associated with a history of syphilis," Scythes notes. "The classical literature has reference after reference to AIDS-like deaths from lymphomas, cancers, Kaposi's sarcoma, pneumonias and tuberculosis in populations known to be suffering from inadequately or untreated chronic syphilis, yet we ignore that in the AIDS era."

His crusade to shed light on this issue has put him in touch with many of the world's leading syphilis experts and has taken him to over a dozen medical conferences, including this latest meeting, where he's been invited to make a presentation.

Scythes points out that not only do the symptoms of untreated end-stage syphilis and AIDS overlap, but many of the body's responses to a chronic syphilis infection -- such as an overdriven immune system and abnormalities in blood cells called T-cells -- also parallel those seen in AIDS.

Immunologist Doug MacFadden, who heads the HIV clinic at Toronto Western Hospital, has also been looking into the behaviour of syphilis in the AIDS era.

"We started out by doing a survey," recalls MacFadden, "and did a blood test on everyone who walked into the office. The first thing we noticed was that we weren't finding any positive VDRLs (the standard screening test for syphilis). These were all male, all gay, living in downtown Toronto, and none of them had any syphilis in the past?"

Test fails

MacFadden became suspicious.

"There was this shockingly remarkable disappearance of syphilis in Toronto. It just didn't sit well. It was no proof of anything, just an indication that something a little unusual might be happening that we should look into a bit further."

MacFadden subsequently discovered the presence of specific antibodies to syphilis in people who never reported a history of syphilis and who failed to react on the VDRL test.

"That was quite interesting", he says. "It reaffirmed that you can have syphilis and not know it."

Since then, the U.S. Centers for Disease Control (CDC) has acknowledged that a negative VDRL test may not necessarily rule out the presence of syphilis in HIV-positive individuals.

Furthermore, MacFadden, along with other researchers, has documented in HIV-positive people an unusual disappearance of their specific antibodies to syphilis from an otherwise supercharged immune response. This selective loss of antibodies, normally maintained for decades, is seen by some leading syphilis experts as a highly significant phenomenon, in that it seems to occur almost exclusively in HIV-positive persons.

Scythes has enlisted the support of several local physicians in examining blood samples from their practices, and irregularities continue to be documented in the syphilis blood tests. These irregularities have occurred so often that a colleague of MacFadden's can now accurately guess, without being told, a person's HIV status simply by examining the results of their various syphilis blood tests.

MacFadden hopes to isolate the syphilis organism from the blood of people who test negative for syphilis to prove that current tests are inadequate in detecting the disease.

The current tests are still able to show a recent syphilis infection in an otherwise healthy individual. But if one's immune system is already compromised by other viral infections, drugs, or especially by a prior syphilis infection that wasn't promptly treated, the usual symptoms and blood markers may not appear, and a recent infection may go unnoticed and progress into a latent stage.

The organism then stops dividing and hides away in the body, where it can escape detection and, unlike regular syphilis, becomes difficult, although not impossible, to transmit.

AIDS mirror

Syphilis in its latent form would thus spread in the same manner as AIDS, whether among gay men, IV drug users, infants of infected mothers, transfusion cases and hemophiliacs receiving the blood-clotting agent Factor 8.

What's more, Scythes suspects that in people with weak immune systems, this latent infection may take a dangerous and unpredictable course, with potentially life-threatening consequences.

McFadden sees it differently.

"Latent syphilis cannot cause disease," he maintains. But he speculates, "If one loses one's syphilis antibody, does that create a state where the organism may be reactivated and start dividing with impunity? I wish I knew."

Local physician Michael Hulton is skeptical of the syphilis connection, however.

"If you believe syphilis causes immune dysfunction, then why don't the classic syphilis treatments help?" he asks. "We've tried prolonged antibiotics, and one of the patients came down with pneumocystis pneumonia."

However, it's well known that penicillin (the most common antibiotic) has no effect on latent syphilis, since the organism only affects organisms in the process of dividing. As well, there are strong suggestions that antibiotics may require a competent immune response to work at all.

The trick lies in getting the bugs to divide - otherwise, they won't respond to antibiotics or the body's own antibodies. This explains why penicillin would fail to improve the condition of someone suffering from a latent syphilis infection.

But it's clear antibiotics cause something to happen. Some AlDS patients given penicillin injections experience violent fevers and other symptoms suggestive of a reawakened immune response to a syphilis infection.

In fact, McFadden has even observed an AIDS patient who'd lost his syphilis antibodies suddenly regain them when treated with penicillin, something he finds "tremendously curious," although it's unclear exactly what this means.

Skeptical doctors

The connection between AIDS and syphilis is still largely speculative, making physicians like Hulton apprehensive, even skeptical.

'"This is syphilis that we can't detect by the current tests, does not behave like normal syphilis, and does not respond to anti-syphilitic agents, so you have three retreats from standard syphilis theory," comments Hulton. "I find that difficult to accept."

In many ways, though, HIV suffers from the same weaknesses -- the virus itself is also difficult to detect in any significant amounts in the blood, is said to behave quite differently from most other retroviruses, and anti-HIV therapies have yet to provide significant long-term benefit. And while HIV has never made animals sick, several animal models exist for syphilis-associated immune suppression and opportunistic infections.

Ten years into the AIDS epidemic, it's frightening to contemplate an epidemic of masked, chronic end-stage syphilis on the loose. But the writing has been on the wall for years. In 1981, the Centers for Disease Control estimated there were 200,000 undiagnosed and untreated cases of syphilis among U.S gay men.

Still, not a single AIDS death has been attributed to complications of syphilis, even though it should be rampant, in its chronic form, in precisely the same groups at risk for AIDS.

"This is impossible," exclaims Scythes. "The British warned the Americans in the 70s that only a third to a half of syphilis cases were being treated, and along comes HIV disease, and syphilis disappears? I can't accept that. It can't have gone away."

NOW JANUARY 3-9, 1991

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