Syphilis rates are rising relentlessly in Britain

NO ONE WANTS syphilis. Not personally—its symptoms include ulcers and insanity—and not nationally. The “French disease” as the English long called it, is an infamously “othered” illness. In 2014 academics in Bucharest traced its linguistic history and found that, even as the English used to call it the French disease, the French called it the Neapolitan one.

The othering didn’t stop there. The Russians called it Polish, the Poles called it German, the Germans called it French and the Danish called it Spanish. The Turks eschewed nationalism for sectarianism, calling it the “Christian disease”, while, as the researchers observed: “in Northern India, the Muslims blamed the Hindu for the outbreak of the affliction. However, the Hindu blamed the Muslims and in the end everyone blamed the Europeans.” Not, perhaps, without cause.

Syphilis also feels like an antiquated disease. It is not. Cases have been rising relentlessly for 20 years in Britain. As a recent paper in Nature Microbiology observed, over the past decade rates have risen by about 150% in some high-income countries. In 1999, 415 cases were reported at clinics in England and Wales. In 2019 there were 8,011 in England alone. (The pandemic makes later figures unreliable.) The numbers are still low. But the rise is worrying. Ironically, some of the reasons are probably positive.

In the 18th and 19th centuries, Britain was a profoundly poxy place. Accurate antique syphilis rates are hard to come by (doctors avoided mentioning it on death certificates as it upset the relatives), but it is estimated that almost 8% of Victorians suffered from it. Rates were lowest among agricultural labourers and much higher among the upper classes. Lord Elgin is famous today for defacing the profile of the Parthenon: in his own time he was known for his own defaced profile. His nose was so eaten away by “the pox” (as Byron put it) that he had to retire from public life.

Effective 20th-century treatments, particularly penicillin, changed that and syphilis rates tumbled. The terrifying arrival of HIV caused rates to collapse as people avoided sexual risk. Now, says Michael Marks, a researcher at the London School of Hygiene and Tropical Medicine (LSHTM) and one of the Nature Microbiology paper’s authors, drugs for HIV are highly effective at prolonging healthy life—and that seems to have led to rises in risky sexual behaviours, especially sex without condoms. That, in turn, has contributed to a resurgence of syphilis, especially among men who have sex with men. Such factors have also led to rises in other sexually transmitted infections (STIs). In 2018 diagnoses of chlamydia, the commonest, rose by 2%, despite a drop in testing, while gonorrhoea diagnoses rose by 26%.

Better treatment and waning terror are clearly good things. But other reasons for rising cases are less positive. Sexual-health services have seen their funding slashed in recent years. Shame, moreover, means new infections are less likely to be diagnosed and treated quickly. “It’s an area full of stigma,” says Emma Harding-Esch, another researcher at the LSHTM. “STIs, ironically, are not considered sexy diseases.”

And syphilis is one of the least sexy. Even now, when its days of linguistic othering are over, it is still seen as “something that affects other people,” says Dr Marks. That needs to change: the “French disease” is becoming a British disease again. ■

This article appeared in the Britain section of the print edition under the headline “Poxy reasoning”