In current times syphilis can be considered a re-emergent sexually transmitted infection and a crucial public health problem, with a worldwide overall rate increase. In particular, in the United States a total of 27,814 cases were reported in 2016, with a rate of 8.7 cases per 100,000 population, which represents a 74.0% increase compared with 2012.1
The origins and antiquity of syphilis have long been controversial, resulting in a debated and unresolved problem for the history of medicine. Traditionally, 2 main hypotheses are accepted: the “Columbian theory,” which asserts that the treponemal infection originated in the New World and was transmitted to Europe by the returning of Columbus from America, and the “pre-Columbian theory,” which claims that the disease was already present in the Old World and evolved into a more virulent form in the 15th century.2
As a matter of fact, syphilis appeared in Europe with a violent outbreak at the end of the 15th century during the siege of Naples by the mercenary troops of Charles VIII3; the disease then spread all over Europe, brutally afflicting a virgin host population.
Alongside the written sources, iconographic representations of the early phases of the syphilitic epidemic are mainly schematic and generic and only show anonymous corpses covered by pustules, or patients placed in barrels for mercurial treatments.4
It is thus interesting to focus more specifically on a portrait painted by Hans Holbein the Younger, an eminent German exponent of Renaissance art. The work was created in 1523, barely 3 decades after the drastic peak virulence of syphilis in Europe, and can be assumed the first genuine representation of a well-identified patient affected by a chronic form of syphilis in a realistic manner.
The emaciated face depicted belongs to Ulrich von Hutten (1488-1523), a German humanist, chevalier, and theologian, considered the “best-known syphilitic in history”5; the identification is confirmed by an inscription (no longer present) on the painting Porträt U. von Hutten in seinem Todesjahr (portrait of von Hutten in his year of death). The realistic painting shows the typical secondary syphilitic efflorescences on the face skin (Figure).
The diagnosis of lue was confirmed by von Hutten himself, an invaluable first-hand witness of the early history of syphilis; he experienced the disease for several years, describing in detail the symptoms in several of his writings (ie, De guaiaci medicina et morbo gallico, 1518).6 Indeed, a paleopathologic examination of the human skeletal remains belonging to von Hutten, exhumed in 1968, showed signs of gummatous osteomyelitis of the long bones.7 Therefore, the painting of Hans Holbein the Younger represents the first realistic portrait of a sure case of syphilis during a peak virulence of the epidemic 3 decades after its first appearance in Europe, providing a perfect match between artistic representation, historical sources, and paleopathologic evidence of the disease.
Despite the introduction of penicillin in 1943, which has represented a turning point in the treatment of syphilis, an attitude of complacency toward sexually transmitted diseases is partially responsible for its current increased diffusion; the perception that syphilis has become an easily curable venereal infection should not minimize the relevance of prevention through safe sexual behaviors.
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-Giulia Riccomi, MSc, Valentina Giuffra, PhD
This article originally appeared in the June issue of The American Journal of Medicine.
