Dissecting Presidential Neurosyphilis Speculation

As the world tries to explain the decisions, mannerisms, and behavior of the new US president, several explanations have been proffered. One particularly interesting conjecture, made by infectious disease physician Steven Beutler, involves neurosyphilis.

Extrapolating from the president's statements to Howard Stern about his experiences trying to avoid sexually transmitted infections, Dr. Beutler raises the issue of neurosyphilis. 

Syphilis is a very common infectious disease that has a prolific and storied past in which it infected people of all walks of life, including many famous individuals. It has various stages that, if untreated, can progress. Neurosyphilis is a late stage manifestation of infection and can cause neuropsychiatric disturbances. In fact, syphilis status is often checked in those presenting with neuropsychiatric symptoms at an older age. 

While primary syphilis cases have been increasing in recent years, cases of neurosyphilis in general are rare in the non-HIV positive population. Syphilis is caused by a bacteria called Treponema pallidum and it is usually exquisitely sensitive to antibiotics of the penicillin class and it has been suggested that all the courses of amoxicillin and other medications given (appropriately and inappropriately for sore throats, bronchitis, other STIs, and the like have blunted the development of late stage syphilis in those incubating the infection. 

While neurosyphilis can definitely cause erratic behavior and psychiatric disturbances I do not believe, in this case, it is ultimately the underlying explanation for this phenomenon. But this type of speculation regarding presidents is not new.

Not Your Father's Syphilis

I just finished reading Robert Harris' An Officer and A Spy which fictionalizes The Dreyfus Affair, a horrible miscarriage of justice that occurred in post Franco-Prussian War France. 

There was only one mention of an infectious disease in the novel and it involved Colonel Jean Sandherr, the head of counter-espionage for the French military responsible for the false case against Alfred Dreyfus.

Harris describes Sandherr as suffering from general paresis caused by syphilis. This complication occurs in late stage syphilis in which the invading spirochete, Treponema palladium, has caused a chronic meningitis that leads to degenerative changes in the brain. 

Every so often, I get consulted on a case of an elderly individual being worked up for dementia because, as part of that workup, a syphilis test is ordered and returns positive. While I've never seen a case of general paresis, these individuals have "late latent" syphilis and undergo treatment (which never really changes the course of their dementia). 

Common in earlier eras, this stage of syphilis is quite rare today. However, the earlier stages of syphilis still abound and, in recent years, the bacterium has become tech-savvy as it has now begun to use social-networking sex apps to find new victims. It seems to have found success  as cases doubled between 2005 and 2013, primarily in men who have sex with men.

At least there's no worry about syphilis being bewildered in the modern digital world because included in the internet of everything are the every resilient STDs.