The Brown School hosted a virtual Open Classroom on “Syphilis: An Infectious Disease Perpetuated by Social Inequities,” presented by Dr. Jason Newland, professor of pediatrics, as part of its 2024 Black History Month Speaker Series, Feb. 13. 

In his presentation, Newland not only explained the stages of syphilis and its many harmful effects, but also provided a history of some of the United States’ immoral syphilis testing, such as in Tuskegee, Alabama and Guatemala. Newland emphasized the importance of remembering our past mistakes and learning from them. 

Newland began his presentation by asking audience members  what they thought of when they read the title of the presentation, and who they generally think of when they hear the word “syphilis.”

“Did it make you uncomfortable?” Newland asked. “Did you have an image of what that person with syphilis looks like? The first piece talks about the stigma of sexually transmitted infections that likely leads to some of the problems we have in our current ability to treat, and then the second piece is who you see when you hear the word syphilis is potentially rooted in the histories associated with syphilis, and a lot of that has to do with being black or brown.”

According to Newland, the story of syphilis dates back thousands of years, with it being the first recognized sexually transmitted infection. He said that syphilis is transmitted through breaks in the skin or mucosal layer, and is transmitted most commonly in the early stages of syphilis.

Newland stated that the first stage of syphilis is primary syphilis, which is often characterized by a chancre — a painless, nontender, ulcerated lesion. However, women will likely develop swollen lymph nodes instead. He added that chancres will go away without treatment, leading to potential issues with overall treatment.

“So you could have syphilis, not know it, not realize it, and [the chancre] is gone,” Newland said. “So think about access issues. Think ‘oh, I don’t know if I want to go see the doctor, I don’t know if there’s something wrong.’ You can see how you might not get treated.”

Newland said that if you are not treated, however, you will develop secondary syphilis. This stage is where the syphilis spreads to most other organs and can lead to neurosyphilis. According to Newland, the side effects from the secondary stage can also disappear, only to resurge later on and progress into tertiary syphilis, which is even more devastating.

“All of these [tertiary syphilis effects] can lead to significant complications, as well as death,” Newland said.

After giving an overview of the disease, Newland displayed a graph that depicts an increasing total rate of syphilis in the U.S. with a higher rate of syphilis among black populations than white populations. Then, Newland began his talk on U.S. Public Health Service Syphilis Studies. 

“There are many, many atrocities in medical research,” Newland said. “Before the syphilis studies, after the syphilis studies. The notion that there is mistrust among our communities of color is not just based on one or two studies.”

First, Newland discussed a 1940s U.S. STD study in Guatemala. He said researchers tested over one thousand vulnerable people, including orphaned children, prisoners, and psychiatric patients, and even inoculated some of these people with syphilis to see what happened. 

“This is one of those stories that’s not talked about,” Newland said. “This is one of those stories that I think needs to be more present, and to be remembered every year, especially among us who do research.”

Newland then discussed the longest, non-therapeutic experiment on humans in medical history: the syphilis study in Tuskegee. Newland highlighted the wishes of those whose families were affected by the study that the experiment be referred to as “in Tuskegee” rather than the “Tuskegee study,” as Tuskegee had no ownership of the study. Newland stated that it is clear the Tuskegee Institute wanted treatments to be given to the patients.

This study was most certainly driven by racism and discrimination against the economically disadvantaged, Newland said. He revealed that the researchers decided that Macon County was a natural laboratory — home to low-income black people that they perceived were not worth treating. At the time, African Americans were viewed as a “notoriously syphilis-soaked race,” Newland added.

“[The head of the experiment’s statement suggests] that our black colleagues and friends didn’t even want to be treated for an infectious disease,” Newland said. “Some might say we still have some of those views towards our colleagues and friends.”

Dr. Newland explained that the experiment included over 600 low-income black males who were told they had “bad blood.” He said that these men were given tests disguised as “treatments” by the researchers. However, most “treatments” were actually placeboes, and other doctors were instructed to not treat these patients, according to Newland. He added that there were syphilis treatments in the 30s, and a big push to treat syphilis too, yet the patients were not told about either of these things.

“[The researchers] wanted to know the complications [of syphilis], there was no treatment,” Newland said. “There was no informed consent. There was no supplied information or knowledge.”

Newland said that the experiment lasted from 1932 to 1972, until a doctor discovered information about the study and leaked it to the press. Of the 439 participants with syphilis, 128 of them had died by the experiment’s completion, and 40 wives of the men had contracted the disease, leading to kids with congenital syphilis.

Newland ended his presentation by stating that congenital syphilis cases have increased by over 700% in the last decade, mostly due to failure to treat/test in a timely and proper way. He also said that the black community is also affected the most by congenital syphilis.

“It is about more than just the demographics; it’s about not having optimal prenatal care or housing instability [and more],” Newland said. “It is so multifactorial, and it is so rooted in a lot of the inequities we have and they continue to be going forward.”

Despite syphilis and inequity being a widespread problem, Newland emphasized the role of individuals in the fight against inequality.

“If we don’t remember and understand the history, it is clear: we’ll keep doing it,” Newland said. “We have to be activists, we have to vote, because our communities are dependent on a person walking into a room and being a person, no matter the way they look, act, or what their sexual orientation or gender is. I think medical research can help that, but we have a lot to do.”