Monogamy Archives - Jeffrey Sterling, MD

Straight, No Chaser: Syphilis Prevention, Treatment and the Tuskegee Experience

Introduction

Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.

The Tuskegee Experiments

In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.

The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

Aftermath

The aftermath of the study includes the following:

Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.

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Straight, No Chaser: Syphilis Prevention, Treatment and the Tuskegee Experience

Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.
Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.
In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.
The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

The aftermath of the study includes the following:

Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.
Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.
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