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Untreated syphilis in the male negro

1955; Pergamon Press; Volume: 1; Issue: 2 Linguagem: Inglês

10.1016/0021-9681(55)90204-6

1878-0679

Jesse J. Peters, James H. Peers, S Olansky, John C. Cutler, Geraldine A. Gleeson,

Syphilis Diagnosis and Treatment

1. A study of the comparative incidence of the morphologic lesions found among ninety-two untreated syphilitic patients and thirty-two control patients examined at autopsy is presented. 2. The gross and microscopic findings on the individuals included in this study indicate that the lesions characteristic of syphilitic involvement in the Negro male are to be found for the most part in the cardiovascular system. For this reason, a detailed analysis of the cardiovascular abnormalities, including the relationship of clinical and autopsy findings, is included. 3. Linear striation of the thoracic aorta was found to be the most reliable gross sign of syphilitic aortitis, while thickening of the aorta wall and necrosis of the media were found to be pathognomonic of syphilitic aortitis in the microscopic examination. 4. In thirty-seven (41.6 per cent) of the eighty-seven syphilitic patients in whom the aorta was examined grossly and microscopically, there was no evidence of syphilitic aortitis by either examination, and in twenty-five (28.1 per cent) of the patients, aortitis was diagnosed by both gross and microscopic findings. 5. On the basis of the findings in this study, it is estimated that a Negro male with syphilis of more than ten years' duration for which he had received no treatment (or less than 12 units of routine treatment) and with sustained seropositivity prior to death would have, roughly, a 50-50 chance of demonstrating syphilitic cardiovascular involvement at autopsy. 6. The unusually high prevalence of cardiac hypertrophy in this study group is believed to be due to the presence of compensatory hypertrophy caused by hypertension and/or myocardial degeneration. 7. The similarity of the clinical signs and symptoms of syphilitic and arteriosclerotic aortitis reduces the efficiency of clinical methods in the detection of syphilitic aortitis. 8. The brain was examined in forty-six of the ninety-two syphilitic patients autopsied. The two patients showing clinical symptoms of central nervous system involvement (paresis and meningovascular syphilis) were among the group examined. The patient diagnosed with meningovascular syphilis showed microscopic cortical atrophy at autopsy, and both patients were found to have opacity of the pia-arachnoid and perivascular and meningeal cellular infiltration. 9. In the respiratory, digestive, hematopoietic, endocrine, urinary, and reproductive systems of the human body, the incidence of abnormalities among syphilitic patients was not significantly different from that among the control patients. 10. In twenty-eight (30.4 per cent) of the ninety-two syphilitic patients examined at autopsy, syphilitic involvement of the cardiovascular or the central nervous system was established as the primary cause of death. The distribution of the causes of death among the syphilitic patients, aside from syphilis itself, was not different from that in the nonsyphilitic group.