WEBVTT - Ep 36 Shades of Syphilis 0:00:00.760 --> 0:00:04.720 With this poison, anything is possible. It assumes the most 0:00:04.800 --> 0:00:08.840 unexpected and disconcerting forms. It almost seems to know the 0:00:08.920 --> 0:00:12.880 ridiculous shame it inspires, so it kills under a disguise. 0:00:13.240 --> 0:00:16.840 It makes its victims die of an intestinal obstruction, for example, 0:00:17.280 --> 0:00:20.400 or a nice little liver disease. You don't recover, but 0:00:20.440 --> 0:00:23.360 your honor is safe. At least the bereave don't have 0:00:23.400 --> 0:00:26.239 to blush at the mention of the deceased. So much 0:00:26.280 --> 0:00:30.240 for its caprices, but it also has its little habits. 0:00:30.360 --> 0:00:33.240 It loves to come out into the daylight, and then 0:00:33.320 --> 0:00:38.199 you get the whole garden full of cutaneous manifestations, those burgeonings, 0:00:38.240 --> 0:00:42.800 those dreadful efflorescences, the lupus. You can find fine examples 0:00:42.800 --> 0:00:45.360 of them all at Saint Louis or in its museum. 0:00:45.720 --> 0:00:49.920 And of course it eats away your bones. But above all, 0:00:50.080 --> 0:00:54.080 you see, the disease attacks the nervous system. That's its 0:00:54.120 --> 0:00:58.680 treat its dessert. It chooses its spot. It snaps the 0:00:58.680 --> 0:01:01.400 network of the nerves at winds. It can cut off 0:01:01.400 --> 0:01:05.360 communication with the outside world, suppress the five senses, and 0:01:05.400 --> 0:01:09.000 then we've got a pretty bouquet of infirmities or It 0:01:09.080 --> 0:01:11.080 plays with a man as if he were a puppet. 0:01:11.319 --> 0:01:13.480 By pinching the nerve at the right spot. It makes 0:01:13.520 --> 0:01:17.120 him jump or dance or start. Then, tired of this, 0:01:17.280 --> 0:01:20.560 it casts him aside, legs broken, and then we have 0:01:20.640 --> 0:01:24.120 a taxia, such a cruel game. You have heard tell, 0:01:24.200 --> 0:01:27.039 for instance, of the acute pain which strikes unendingly in 0:01:27.080 --> 0:01:30.479 the small of your back, or perhaps it lays into 0:01:30.480 --> 0:01:33.479 the brain, the kingpin of it all. And there's your 0:01:33.480 --> 0:02:21.000 general paralysis, sinility, and all its glory, all its regularity. 0:02:21.840 --> 0:02:23.040 I loved that description. 0:02:24.040 --> 0:02:30.040 Yeah, that's from this book called History of Syphilis. 0:02:30.280 --> 0:02:33.160 Well believe it or not. Jumping right into it, jumping 0:02:33.280 --> 0:02:37.120 right in. Oh yeah. So Hi, I'm Aaron Welsh. 0:02:36.639 --> 0:02:38.520 And I'm Erin Almond Updyke. 0:02:38.280 --> 0:02:40.120 And this is this podcast Will. 0:02:40.040 --> 0:02:44.239 Kill You Season three, Season three, and we're starting off 0:02:44.320 --> 0:02:46.720 with a bang by covering. 0:02:46.840 --> 0:02:53.560 A classic, a very classic syphilis. I'm very excited about today. 0:02:54.200 --> 0:02:56.160 Yeah, we've been wanting to do this one for a 0:02:56.200 --> 0:02:59.639 while and it's been highly requested, and I think we've 0:02:59.680 --> 0:03:02.360 been saving it because it's such a. 0:03:02.280 --> 0:03:07.160 Big one and it feels a bit daunting. So hopefully 0:03:07.840 --> 0:03:09.000 you get your fill. 0:03:09.080 --> 0:03:11.040 I think this was kind of on our short list 0:03:11.080 --> 0:03:13.799 for the first season, wasn't it because it's such a big, 0:03:14.160 --> 0:03:14.679 big one. 0:03:15.000 --> 0:03:18.519 It was, But I'm glad that we saved it. Me too. 0:03:19.400 --> 0:03:24.040 So because we're doing syphilis, we should maybe preface this 0:03:24.120 --> 0:03:25.119 with a bit of warning. 0:03:25.440 --> 0:03:31.120 Yes, if you are so, syphilis is a sexually transmitted disease, 0:03:31.160 --> 0:03:36.960 which means we will be talking about genitalia and sex. 0:03:37.960 --> 0:03:40.000 So if you're listening with young ones that you don't 0:03:40.040 --> 0:03:42.840 want to hear those things, maybe skip this episode. Come 0:03:42.880 --> 0:03:44.520 back in two weeks up to you. 0:03:44.960 --> 0:03:51.000 Yeah, okay, So first episode of season three. A lot 0:03:51.040 --> 0:03:52.040 of things have happened. 0:03:52.320 --> 0:03:55.760 So many things have happened, and it hasn't even been 0:03:55.800 --> 0:03:57.520 that long since season two ended. 0:03:57.720 --> 0:04:01.440 No it hasn't. So Aaron, tell us about some of 0:04:01.480 --> 0:04:04.960 the things that happened for you since we ended season two. 0:04:05.600 --> 0:04:09.520 I am back in the United States, and so now 0:04:09.560 --> 0:04:12.080 we get to record in the same time zone at least, 0:04:12.160 --> 0:04:14.080 even if it's not in the same location. But there 0:04:14.120 --> 0:04:17.279 will be upcoming same recordings, which will be excellent. 0:04:17.480 --> 0:04:19.960 That'll be way more fun. But it's really nice to 0:04:20.000 --> 0:04:21.200 be on the same time zone. 0:04:21.720 --> 0:04:24.080 Is and aeron what's up with you? 0:04:24.520 --> 0:04:28.279 Well, you might hear throughout this episode, tiny little squeals 0:04:28.720 --> 0:04:31.960 of my baby human who is sitting here near me, 0:04:34.480 --> 0:04:38.640 the keenest. He's very cute. And hopefully we'll sleep through 0:04:38.640 --> 0:04:42.440 this recording, but if not, we'll take breaks. Yeah, baby, 0:04:42.920 --> 0:04:48.280 no problem. Okay, So right, that's us all caught up. 0:04:49.520 --> 0:04:50.840 Do we have any more business? 0:04:52.240 --> 0:04:52.600 Yeah? 0:04:52.640 --> 0:04:56.000 So we still have merchandise, so go take a look 0:04:56.000 --> 0:04:59.200 at that. And we also will have new soap coming out, 0:04:59.440 --> 0:05:03.880 new new scent which is going to be super delicious smelling. 0:05:04.200 --> 0:05:06.159 Yeah, a kind of fall scent. 0:05:06.640 --> 0:05:10.400 Yeah. Yeah, I'm excited about it. Where can you find 0:05:10.440 --> 0:05:10.720 all of this? 0:05:11.400 --> 0:05:13.560 You can get to it all from our website. This 0:05:13.640 --> 0:05:17.839 podcast will kill You dot com under merch perfect It's 0:05:17.880 --> 0:05:18.440 pretty easy. 0:05:18.800 --> 0:05:25.119 Okay, onto more important things. Yes, it's corn teeny time. 0:05:25.640 --> 0:05:27.880 Oh, it's been so long since we've gotten to say 0:05:27.920 --> 0:05:30.920 those words, and. 0:05:30.920 --> 0:05:33.000 Since you've been able to actually participate. 0:05:33.200 --> 0:05:35.440 I know, And I'm not even right now, which is 0:05:35.560 --> 0:05:41.919 really disappointing, but I will be again soon. Quarantiny time, Aaron, 0:05:42.000 --> 0:05:43.239 What are we drinking today? 0:05:43.720 --> 0:05:49.839 We are drinking the Killer Cure Ooh it has mold 0:05:49.920 --> 0:05:56.120 cider of course, rye whiskey, ginger liqueur okay, and Walnut 0:05:56.120 --> 0:05:57.719 Liqueur or Walnut bitters. 0:05:57.400 --> 0:05:59.120 If you can find them, fantastic. 0:05:59.560 --> 0:06:03.240 I will recommend Templeton Rye because that was al Capone's 0:06:03.240 --> 0:06:08.200 favorite whiskey and he had syphilis. And shout out to 0:06:08.360 --> 0:06:13.000 our friend Sam for telling me that bit of trivia. 0:06:13.520 --> 0:06:14.159 That's amazing. 0:06:14.240 --> 0:06:16.880 Sam in her pocket knew like, oh yeah, and al 0:06:16.920 --> 0:06:19.600 Capone had syphilis. Yeahd Templeton Rye. 0:06:19.720 --> 0:06:24.160 She had to do a report on famous chicagoans when 0:06:24.240 --> 0:06:26.520 she was like in grade school, and so she chose 0:06:26.640 --> 0:06:29.839 al Capone and always remembered that he had syphilis. 0:06:31.680 --> 0:06:34.000 Oh that's amazing. Yeah, well that's perfect. 0:06:34.560 --> 0:06:38.080 Anyways, we will post the recipe to the quarantiney and 0:06:38.120 --> 0:06:41.279 the non alcoholic placey Berita on our website. This podcast 0:06:41.279 --> 0:06:44.200 will kill you dot com and will also blast it 0:06:44.240 --> 0:06:45.359 all over social media. 0:06:45.640 --> 0:06:48.560 Yes, so if you're not following us on social media, 0:06:48.960 --> 0:06:50.160 you should probably get on that. 0:06:50.440 --> 0:06:51.080 Yeah, props. 0:06:51.960 --> 0:06:58.159 Okay, all right, well then shall we begin our first 0:06:58.200 --> 0:07:00.120 episode of season three? 0:07:00.160 --> 0:07:01.320 Absolutely? 0:07:01.760 --> 0:07:04.400 All right, we'll take a quick short break so everyone 0:07:04.440 --> 0:07:05.960 can go make themselves a quarantine. 0:07:35.800 --> 0:07:40.440 All right, So syphilis, yes, give it to me, don't 0:07:40.480 --> 0:07:41.000 give it me? 0:07:41.280 --> 0:07:45.320 Well, yeah, I'll give you the biology, not the disease. 0:07:45.360 --> 0:07:47.280 How about that? Excellent? 0:07:48.200 --> 0:07:50.520 So one thing that I think is very fun that 0:07:50.600 --> 0:07:54.440 we did not do intentionally, at least I don't think 0:07:54.440 --> 0:07:59.120 we did this intentionally. Syphilis is our second spiral keet 0:07:59.520 --> 0:08:03.800 back to he that's right, And we ended season two 0:08:03.840 --> 0:08:06.200 with the Spira keet, and now we're starting season three 0:08:06.320 --> 0:08:07.240 with the spira keet. 0:08:07.520 --> 0:08:10.000 I have thinking about that meanwather. 0:08:10.640 --> 0:08:13.920 Not intentional, but kind of adorable, all right, So that's 0:08:13.960 --> 0:08:16.360 the first thing we already know. Now we've learned something 0:08:16.400 --> 0:08:19.840 new about syphilis. It's caused by a spira keet bacterium, 0:08:20.240 --> 0:08:23.760 which means like the bacterium that causes lime disease. 0:08:23.960 --> 0:08:24.440 It is a. 0:08:24.440 --> 0:08:27.600 Corkscrew shape and it sort of swims like a little 0:08:28.560 --> 0:08:29.440 what am I doing here? 0:08:29.560 --> 0:08:34.120 Erin you really spiral? Yeah, it's just corkscrew corkscrewing. 0:08:36.760 --> 0:08:42.240 So this bacterium that causes syphalis is called trepanima palladum, tripanema, 0:08:42.240 --> 0:08:46.480 trepanema however you want to say it palladum. Now, something 0:08:46.520 --> 0:08:50.120 that's very interesting about syphilis that's different than the last 0:08:50.160 --> 0:08:54.000 spira keet we did. While lime disease is caused by 0:08:54.120 --> 0:09:00.320 a number of different species, of bacteria. Syphilis is not 0:09:00.360 --> 0:09:03.800 only caused just by one species, but by one particular 0:09:04.120 --> 0:09:08.320 subspecies of one bacteria. 0:09:08.640 --> 0:09:11.560 I was hoping that you were gonna cover this because 0:09:11.640 --> 0:09:16.720 I find this super interesting that it's a subspecies and 0:09:16.800 --> 0:09:20.480 what does that mean for the biology of this disease 0:09:20.600 --> 0:09:24.080 versus the other subspecies in Trepenema paladum. 0:09:24.200 --> 0:09:28.640 It's fascinating. So Trepenema paladum has a number of different 0:09:28.640 --> 0:09:33.400 subspecies that cause completely different diseases aside from syphilis. So 0:09:33.800 --> 0:09:39.000 syphilis is caused by Trepanema paladum subspecies palladum. So Trepenema 0:09:39.040 --> 0:09:42.080 paladum paladum, that's what causes the disease that we're going 0:09:42.160 --> 0:09:44.920 to talk about today. Syphilis also used to be called 0:09:45.000 --> 0:09:50.160 venereal syphilis, so this is the sexually transmitted form of syphilis. However, 0:09:50.559 --> 0:09:56.119 other subspecies of Trepenema paladum cause diseases like yaws. Yeah, 0:09:56.200 --> 0:09:59.400 and I'm not sure how you pronounce it be hell. 0:10:00.000 --> 0:10:03.480 Oh, I was hoping that you were going to try 0:10:03.480 --> 0:10:05.199 to pronounce this first, because I have no clue. 0:10:05.240 --> 0:10:07.160 Nope, I even looked it up and I couldn't find 0:10:07.160 --> 0:10:10.720 a consistent pronunciation. So it's also called endemic syphilis. 0:10:10.840 --> 0:10:14.120 It's spelled b E j E L. Yeah, I don't 0:10:14.160 --> 0:10:14.480 know if. 0:10:14.360 --> 0:10:20.000 It's begel or behel, who knows, but anyways, that's another form. 0:10:20.120 --> 0:10:23.000 And then there's another that I actually I saw it 0:10:23.280 --> 0:10:26.079 listed as a subspecies of Treponema paladam and also as 0:10:26.120 --> 0:10:29.280 another species of Treponema that causes a disease called pinta. 0:10:29.960 --> 0:10:32.000 So I'm actually not clear, but. 0:10:32.080 --> 0:10:34.320 They couldn't, so it's it's I think what I read 0:10:34.440 --> 0:10:37.400 is that pinta is caused by a separate species, and 0:10:37.440 --> 0:10:40.680 that's only because they could not get a bacterial isolate 0:10:41.200 --> 0:10:43.559 of it to determine whether it was a subspecies. 0:10:43.960 --> 0:10:48.040 That seems believable. And what's so interesting about these different 0:10:48.080 --> 0:10:50.920 subspecies is that based on the tests that we use 0:10:51.000 --> 0:10:54.600 to diagnose syphilis, you can't distinguish them from each other. 0:10:54.679 --> 0:10:57.520 So morphologically, when you look at them under a microscope, 0:10:57.640 --> 0:11:00.720 they're identical. The test that we used to diagnose them, 0:11:01.040 --> 0:11:04.839 you can't tell them apart. There are tiny, tiny differences 0:11:04.880 --> 0:11:09.040 in their genomes that result in small differences in proteins 0:11:09.559 --> 0:11:12.760 that if you do very specific tests that nobody does 0:11:12.760 --> 0:11:15.600 in real life, you can tell them apart. But The 0:11:15.640 --> 0:11:19.200 reason that we classify them as different subspecies before we 0:11:19.280 --> 0:11:22.960 had those tests is because they're clinical manifestations. So the 0:11:23.000 --> 0:11:26.800 way they present in people is totally different, and the 0:11:26.800 --> 0:11:31.080 way that they're transmitted is different. So these other diseases 0:11:31.520 --> 0:11:36.960 caused by Trepenima paladum different subspecies are not transmitted sexually. 0:11:37.160 --> 0:11:39.280 They're transmitted in other ways that we're not going to. 0:11:39.280 --> 0:11:40.000 Talk about today. 0:11:40.280 --> 0:11:45.040 Right, So that's our first fun fact. Trepenema paladum subspecies 0:11:45.240 --> 0:11:48.000 paladum causing syphilis. 0:11:48.440 --> 0:11:49.760 Fun, very fun fact. 0:11:50.280 --> 0:11:52.760 Such fun. That's as fun as it gets. It's downhill 0:11:52.760 --> 0:11:53.120 from here. 0:11:54.360 --> 0:11:54.800 Okay. 0:11:55.120 --> 0:11:58.000 So syphilis, as most people are aware, and as we've 0:11:58.000 --> 0:12:01.320 said already, is a sexually transmitted infection. It can be 0:12:01.400 --> 0:12:06.080 spread through any type of sexual contact. We're talking all 0:12:06.120 --> 0:12:09.360 the different kinds of sex. So syphilis is a very 0:12:09.480 --> 0:12:13.640 very tiny spiralkeet. So the way it's transmitted is essentially 0:12:13.760 --> 0:12:17.160 just when you come into contact with the bacteria through 0:12:17.200 --> 0:12:21.000 direct skin on skin or skin on mucous membrane contact, 0:12:21.720 --> 0:12:24.720 the bacteria is able to just cork screw its little 0:12:24.760 --> 0:12:27.760 way in between the tiny gaps in your skin cells, 0:12:28.280 --> 0:12:32.680 either if you have microscopic little tears or just through 0:12:32.720 --> 0:12:35.880 your mucous membranes like your genitalia, where the skin is 0:12:36.000 --> 0:12:40.640 very thin and very moist. Syphilis can also pass through 0:12:40.679 --> 0:12:44.560 the placenta and be transmitted congenitally, so from mother to infant, 0:12:45.400 --> 0:12:47.720 and in some cases it can even be transmitted to 0:12:47.800 --> 0:12:51.480 a baby during birth, like through the birth canal Okay, 0:12:51.960 --> 0:12:56.120 And once it penetrates the skin, the bacterium pretty quickly 0:12:56.280 --> 0:12:59.560 makes its way into your bloodstream and from there, as 0:12:59.640 --> 0:13:02.079 we saw in that first hand account, it can travel 0:13:02.240 --> 0:13:06.600 to and invade pretty much any organ. It can even 0:13:06.640 --> 0:13:09.120 cross the blood brain barrier and make its way into 0:13:09.160 --> 0:13:13.520 your nervous system. Yeah yeah, And as it travels through 0:13:13.520 --> 0:13:16.920 your bloodstream, it turns out that it stimulates a lot 0:13:16.960 --> 0:13:19.640 of inflammation on the part of your immune system, and 0:13:19.720 --> 0:13:22.800 this inflammation is what causes a lot of the symptoms 0:13:22.840 --> 0:13:25.920 that we see. There are a few specific organs that 0:13:25.960 --> 0:13:29.760 it tends to infect, like preferentially for some reason or another, 0:13:30.000 --> 0:13:33.120 and we'll talk about those, but it can invade almost 0:13:33.120 --> 0:13:36.320 any organ just by swimming its way through your bloodstream. 0:13:36.720 --> 0:13:37.240 Yikes. 0:13:37.760 --> 0:13:40.520 Yeah, let's start talking about the actual symptoms. So now 0:13:40.520 --> 0:13:42.360 we know this is how it's going to cause them. Right, 0:13:42.400 --> 0:13:45.480 it's traveling through your bloodstream causing inflammation. 0:13:45.040 --> 0:13:45.560 As it goes. 0:13:45.800 --> 0:13:49.040 Okay, so what are the actual symptoms. There's three main 0:13:49.120 --> 0:13:54.840 phases of syphilis primary, secondary, and tertiary very creative names. 0:13:55.440 --> 0:13:57.920 And then it can also lay latent, so between the 0:13:57.960 --> 0:14:03.000 secondary and tertiary phase you can have years long latency 0:14:03.240 --> 0:14:08.280 where there are bacteria there, but you don't have active disease, 0:14:08.360 --> 0:14:12.079 so you wouldn't know that you're infected. So the primary 0:14:12.120 --> 0:14:16.600 stage usually presents within three weeks of infection. So the 0:14:16.640 --> 0:14:19.960 incubation period on average is about three weeks. It can 0:14:20.000 --> 0:14:23.360 be less, it can be more, and it usually the 0:14:23.400 --> 0:14:28.120 primary stage is essentially a shanker, that's what it's called. 0:14:29.120 --> 0:14:33.640 It's essentially just an ulcer, so an open wound that 0:14:33.800 --> 0:14:37.320 is most commonly found on the genitalia because again we're 0:14:37.320 --> 0:14:41.200 talking about a disease that's transmitted sexually. So this shanker, 0:14:41.280 --> 0:14:46.800 this ulcer is essentially chalk full of spira keet bacteria. 0:14:47.560 --> 0:14:50.720 It's just a bunch of spira keets swimming around just 0:14:50.880 --> 0:14:54.000 under the surface of your skin, busting out as they 0:14:54.040 --> 0:14:58.640 go into this open wound. Where is the wound, So 0:14:59.280 --> 0:15:02.760 it's most commonly if you have a penis, on the 0:15:02.760 --> 0:15:05.200 shaft of the penis or the glands of the penis. 0:15:05.360 --> 0:15:09.120 It can be on the labia or inside of the vagina, 0:15:09.640 --> 0:15:13.280 or in the anal canal or around the anis. It 0:15:13.320 --> 0:15:15.360 is possible also for it to be in the mouth 0:15:15.560 --> 0:15:19.320 or there's even been reports of it in physicians before 0:15:19.480 --> 0:15:20.400 gloves were a thing. 0:15:20.640 --> 0:15:21.240 They would get it. 0:15:21.240 --> 0:15:25.920 In their nose. Ah, I know, yeah, it's horrific. So 0:15:25.960 --> 0:15:29.920 it can be on basically any mucous membrane okay, yeah, 0:15:29.960 --> 0:15:34.360 but most commonly on the penis, anis, or labia, or 0:15:34.360 --> 0:15:38.280 inside the vagina. But one thing that is really important 0:15:38.320 --> 0:15:42.280 about this ulcer of primary syphilis is that it's completely 0:15:42.320 --> 0:15:45.720 painless and it doesn't itch, and so that's something that 0:15:45.800 --> 0:15:49.440 distinguishes it from a lot of other genital ulcers is 0:15:49.480 --> 0:15:52.000 that you might not ever know that it's there if 0:15:52.000 --> 0:15:54.560 you're not looking for it, because it doesn't hurt at all, 0:15:55.240 --> 0:15:56.520 and even though it might. 0:15:56.400 --> 0:15:57.160 Bleed a little. 0:15:57.920 --> 0:16:01.520 That's in an area where things just kind of lead sometimes, right. 0:16:01.440 --> 0:16:04.160 And especially if you have if it's like up the 0:16:04.240 --> 0:16:07.440 vaginal canal exactly something, it's much more difficult to spot, right. 0:16:07.520 --> 0:16:10.160 Or even like in the anus like you're probably never 0:16:10.200 --> 0:16:14.240 gonna find that, and so yeah, so it's very possible 0:16:14.320 --> 0:16:18.160 to never know that you have this primary form. 0:16:18.280 --> 0:16:21.920 And the site is usually the site of infection as well, it. 0:16:21.800 --> 0:16:24.800 Is yeah, so yeah, this is something where that's the 0:16:24.840 --> 0:16:33.120 site of infection and it's full of bacteria extraordinarily infectious. Okay, 0:16:33.240 --> 0:16:38.920 so these ulcers are extraordinarily infectious. And usually the ulcer 0:16:38.920 --> 0:16:41.560 will persist between three and six weeks, so it's a 0:16:41.560 --> 0:16:44.880 pretty long lasting ulcer. It doesn't just pop up overnight 0:16:44.920 --> 0:16:47.520 and then disappear overnight. It lasts for quite a while. 0:16:48.880 --> 0:16:54.040 So that's primary syphilis. Secondary syphilis is what happens a 0:16:54.040 --> 0:16:57.240 bit later. So this usually happens after between four and 0:16:57.440 --> 0:17:02.240 ten weeks of after infect so a longer incubation period 0:17:02.520 --> 0:17:09.399 in general. And I'm unclear on exactly how many, like 0:17:09.440 --> 0:17:12.800 what percentage of people go on to develop secondary syphilis 0:17:12.840 --> 0:17:16.440 if primary is untreated. Some numbers I saw said twenty 0:17:16.520 --> 0:17:18.960 five percent, but I saw numbers as high as sixty 0:17:19.040 --> 0:17:24.679 or eighty percent, So honestly, who knows. I don't, but 0:17:24.760 --> 0:17:26.679 a number of people will go on to develop this 0:17:26.960 --> 0:17:32.399 secondary syphilis, and this is I think one of the 0:17:32.440 --> 0:17:35.280 main ways that syphilis got one of its nicknames, which 0:17:35.320 --> 0:17:38.920 was the Great imitator, right, And it's kind of what 0:17:38.960 --> 0:17:41.600 you talked about or touched on in the first hand account. 0:17:42.080 --> 0:17:45.920 This can present in so many different ways because the 0:17:45.960 --> 0:17:50.920 bacteria have gone throughout your entire bloodstream and they can 0:17:51.240 --> 0:17:56.040 essentially invade any organ that they choose, So you can 0:17:56.119 --> 0:18:00.880 have GI manifestations where you have inflammation, and like gastro 0:18:00.920 --> 0:18:05.480 intestinal distress. You can have hippatosplenomegaly where your spleen and 0:18:05.520 --> 0:18:09.280 your liver get infected and then they get really large 0:18:09.440 --> 0:18:14.399 because they're full of inflammation. Hippato is liver spleno is spleen. 0:18:14.720 --> 0:18:17.159 I like that word. It's a good word. I like 0:18:17.200 --> 0:18:17.720 to throw it. 0:18:17.680 --> 0:18:23.000 In whenever I can't. Yeah, you can also get meningitis, 0:18:23.080 --> 0:18:26.760 So if it crosses that blood brain barrier in secondary syphilis, 0:18:26.840 --> 0:18:29.760 you can get meningitis. And it's not uncommon to find 0:18:30.280 --> 0:18:34.840 actual bacteria in the CSF, the spinal fluid. But then 0:18:34.840 --> 0:18:37.359 there are a few other manifestations that are kind of 0:18:39.200 --> 0:18:44.840 not kind of classic secondary syphilis, and most commonly that's 0:18:44.880 --> 0:18:48.440 a rash. And this rash is on the trunk and 0:18:48.560 --> 0:18:52.679 the extremities, and specifically it goes to the palm and 0:18:52.880 --> 0:18:55.400 souls of the feet, So palms of the hands and. 0:18:55.320 --> 0:18:56.080 Soles of the feet. 0:18:56.600 --> 0:19:00.000 There are not a lot of infectious diseases that cause 0:19:00.160 --> 0:19:04.480 a rash on your palms and souls. Huh, isn't that bizarre? 0:19:04.720 --> 0:19:07.040 There's only very bizarre. It's very bizarre. 0:19:07.119 --> 0:19:11.600 There's only three main disorders that we learn in medical 0:19:11.640 --> 0:19:14.560 school that give you rashes on the palms and souls. 0:19:14.680 --> 0:19:19.399 It's secondary syphilis, ricketzial diseases like rocky mountain, spotted fever, 0:19:19.960 --> 0:19:24.920 and uh cocksacky virus handfoot in mouth. Oh okay, those 0:19:24.960 --> 0:19:25.920 are the three big ones. 0:19:26.080 --> 0:19:29.840 How interesting. I wonder what why me too? 0:19:30.280 --> 0:19:31.960 I tried to find out an answer, and I don't 0:19:32.000 --> 0:19:34.480 have a good one. There are other things like obviously 0:19:34.560 --> 0:19:37.959 contact dermatitis. If you like grab your hand onto something 0:19:38.080 --> 0:19:40.760 like poison ivy, yeah you'll get a rash there. But 0:19:40.920 --> 0:19:44.960 in terms of infections, those are the three big ones. Huh. 0:19:45.040 --> 0:19:49.040 I know. So the rash thing, so then if you 0:19:49.240 --> 0:19:52.080 have because it wouldn't just be on one hand either, 0:19:52.080 --> 0:19:54.040 it would be on your palms and your feet. 0:19:54.320 --> 0:19:56.960 Yeah, and usually it's kind of throughout your body as well, 0:19:57.000 --> 0:19:59.159 so it's not only on your palms and souls. 0:19:59.200 --> 0:20:00.800 It's like kind all over. 0:20:00.840 --> 0:20:03.360 And this is the whole great pox versus smallpox sort 0:20:03.400 --> 0:20:04.680 of thing, is the big rash. 0:20:04.840 --> 0:20:07.080 Yeah, So this rash can actually look a lot of 0:20:07.080 --> 0:20:09.760 different ways, if you like Google image search it, which 0:20:09.800 --> 0:20:11.840 I'm sure on our social media will post plenty of 0:20:11.840 --> 0:20:17.160 pictures of this. But it sometimes it's just flat red spots. 0:20:17.640 --> 0:20:23.120 Sometimes it can be raised spots. In people who have 0:20:23.400 --> 0:20:26.400 some kind of immunocompromise, like they don't have a great 0:20:26.440 --> 0:20:30.840 immune system response, they can actually get necrotizing rashes. So 0:20:30.920 --> 0:20:33.679 that's where like this tissue starts to die and they 0:20:33.720 --> 0:20:38.639 get these very large, kind of purple, very dark rash. 0:20:38.720 --> 0:20:43.159 So it can look a lot of different ways. Yeah, 0:20:43.240 --> 0:20:45.560 and then you'll also see other signs of kind of 0:20:45.600 --> 0:20:50.360 systemic involvement, things like fever, sore throat, weight loss, hair loss. 0:20:51.119 --> 0:20:56.840 So that's secondary syphilis, okay. And then there's tertiary dun 0:20:56.960 --> 0:21:01.760 dun dun, Yeah, dun dundun is right after secondary. There's 0:21:02.200 --> 0:21:06.359 often a long latent period where we're talking years past 0:21:06.480 --> 0:21:09.080 between secondary and tertiary. 0:21:09.520 --> 0:21:10.320 And it's also. 0:21:10.200 --> 0:21:13.639 Possible that you can get tertiary syphilis or have signs 0:21:13.640 --> 0:21:18.480 of tertiary syphilis without knowing that you had syphilis, because 0:21:18.520 --> 0:21:22.440 if you only had a primary ulcer and you never 0:21:22.520 --> 0:21:25.639 developed those secondary signs, you might never have known that 0:21:25.680 --> 0:21:29.720 you had that ulcer, and then five, ten, fifteen, twenty 0:21:29.800 --> 0:21:32.959 years down the line, you can develop signs of tertiary syphilis. 0:21:33.359 --> 0:21:37.080 So you can jump essentially from primary to tertiary without 0:21:37.160 --> 0:21:38.119 Yeah you could. 0:21:38.560 --> 0:21:42.320 Yeah, So tertiary syphilis if it goes if primary and 0:21:42.359 --> 0:21:45.679 secondary syphilis goes untreated, it can result years down the 0:21:45.720 --> 0:21:50.480 line in this much more severe form of syphilis. And 0:21:50.720 --> 0:21:56.440 this tertiary third form actually has three different forms itself. 0:21:57.280 --> 0:22:00.960 So there's a cardiovascular form of tertiary syphilis, where as 0:22:00.960 --> 0:22:06.200 you can imagine it affects your heart. There's the gammatis gummatis. 0:22:06.960 --> 0:22:08.840 Oh yeah, the gumma. 0:22:08.680 --> 0:22:11.680 The gumma form, and we'll talk about what the heck 0:22:11.760 --> 0:22:15.000 that means in a second. And then there's neurosyphilis, which 0:22:15.040 --> 0:22:20.080 affects your nervous system. Neurosyphilis is the most famous of these, 0:22:20.160 --> 0:22:23.480 I think, and that's because it was the most common 0:22:23.560 --> 0:22:28.880 before there was treatment for syphilis. Tertiary syphilis, specifically, neurosyphilis 0:22:28.920 --> 0:22:33.240 was the most common form of this late phase of syphilis. 0:22:33.920 --> 0:22:36.280 And there's a few different ways that this can present, 0:22:36.680 --> 0:22:43.440 and they're all absolutely horrific. But the two more devastating 0:22:43.640 --> 0:22:48.280 I suppose forms of neurosyphilis are called general paresis and 0:22:48.720 --> 0:22:53.360 Taby's dorsalis. So we'll talk about each of those. General 0:22:53.400 --> 0:22:58.960 paresis is, so parsis means paralysis, but this is much 0:22:59.000 --> 0:23:03.240 more than just a paraphalysis. This is when basically the 0:23:03.320 --> 0:23:06.239 spiro keet invades your brain in such a way that 0:23:06.320 --> 0:23:09.040 your cerebrum, which is the main part of your brain, 0:23:09.240 --> 0:23:13.119 like the brain shaped part of your brain, starts to atrophy. 0:23:13.800 --> 0:23:15.800 Oh my god, yeah, it's horrific. 0:23:15.920 --> 0:23:21.160 And so you get a dementia, which is basically you know, 0:23:21.560 --> 0:23:25.200 things like memory loss, personality change. 0:23:26.080 --> 0:23:27.760 And then you also get. 0:23:27.560 --> 0:23:33.240 These physical symptoms, so things like trouble speaking, tremors, seizures. 0:23:33.800 --> 0:23:34.760 Your muscles will. 0:23:34.600 --> 0:23:38.399 Eventually start to deteriorate because the connection between your brain 0:23:38.880 --> 0:23:42.199 and your muscles is not working correctly, So your muscles 0:23:42.200 --> 0:23:47.080 start to atrophy because of that, and then eventually complete paralysis. 0:23:47.960 --> 0:23:51.159 Why does this happen, great question. 0:23:52.359 --> 0:23:57.040 I don't know entirely, Especially with general paresis, it's as 0:23:57.040 --> 0:24:00.879 far as I understand it's just the invader of your 0:24:00.960 --> 0:24:05.000 brain itself, your brain and your spinal cord that causes 0:24:05.000 --> 0:24:08.320 this atrophy. So as each part of your brain starts 0:24:08.320 --> 0:24:12.520 to atrophy, you'll see these different manifestations. So that's actually 0:24:12.560 --> 0:24:15.800 not the most common form of neurosyphilis. The most common 0:24:16.000 --> 0:24:18.440 and kind of I know what we learned in med 0:24:18.440 --> 0:24:22.640 school is like, the most classic neurosyphilis is Taby's dorsalis tabs. 0:24:23.000 --> 0:24:27.160 I looked this up. Get my etymology hat on. Tabes 0:24:27.240 --> 0:24:32.400 means wasting away, which is horrific, and dorsalis is like dorsal, 0:24:32.520 --> 0:24:37.080 like dorsal fin so the back part, So Taby's dorsalis 0:24:37.200 --> 0:24:41.440 is literally the wasting away, the degeneration of the posterior 0:24:41.520 --> 0:24:42.800 part of your spinal cord. 0:24:43.240 --> 0:24:44.680 Oh my god. 0:24:45.320 --> 0:24:48.720 So instead of your brain kind of wasting away, it's 0:24:48.880 --> 0:24:52.240 the back part, specifically, just the posterior part of your 0:24:52.240 --> 0:24:56.439 spinal cord. Wow, it happens that that section of your 0:24:56.480 --> 0:24:59.639 spinal cord, the nerves that run through it are mostly 0:24:59.680 --> 0:25:06.480